Letter to the Nation's New Medical Students

The Dean of Stanford University Medical School posted: "This week we were asked by Department of Health and Human Services Secretary Kathleen Sebelius and National Coordinator for Health Information Technology David Blumenthal, MD to distribute the letter that follows to first year medical students." Please click here and scroll down for the letter.

Understanding Insurance: Letter & Response to the April JAOA Article

Dr. Fredericks began the discussion on the need for physicians to be taught the business of medicine in medical school, which led to my response and the subsequent survey in which I invite you to participate.  Please click on the hotlink if you would like to learn more about the business of medicine or if you already have the necessary skills set and experience and are interested in teaching. Thank you -

Insurance Fraud Mushrooms

As was predicted here in April, insurance fraud is now mushrooming, with new schemes popping up to scam the American consumer in 24 states. Section 1322 of the Patient Protection and Affordable Care Act mandated that states create co-ops. Under this legislation, private insurers or related entities in existence before July 16, 2009, cannot qualify as health insurance issuers in co-ops. The co-op provision in HR 3590 necessitates that a number of new nonprofit companies will pop up and apply for startup loans and grants from the federal government.

Who exactly will these new nonprofits be? After paying their premium dollars, will customers get the services they expect? Apparently not, according to a Reuters article published on Tuesday:

“The Federal Trade Commission said on Wednesday it is working with 24 states to crack down on sellers of medical discount plans that market them as health insurance that covers doctors, hospitals and other services. Such scams have increased in the wake of the health care reform law…, said David Vladeck, director of the FTC's Bureau of Consumer Protection…"The uncertainty about the benefits that will be available under the new federal insurance program and the fact that the budget doesn't kick in until 2014 is going to give scammers very fertile ground for this," Vladeck told reporters in a conference call. "They're going to try to capitalize on uncertainty."


…"Health discount plans are not insurance. They don't pay your medical bills," said Minnesota Attorney General Lori Swanson, who has filed three lawsuits. She added that continued job losses are fueling the scams since most Americans who have insurance get it through their employer. The companies targeted by the FTC and states are mostly privately owned. They include Health Care One, Consumer Health Benefits Association, and United States Benefits. So far, 54 lawsuits and other civil enforcement actions have been taken by the FTC and the states, officials said. New York's insurance superintendent, James Wrynn, said some of the discount plans do offer some limited payments for some healthcare expenses such as medical tests or short hospital stays, "but when you find out the extent of the coverage, there is for all intents and purposes, no coverage."

Expect even more fraud in the next few years. Given the state budget deficits most states are facing and ever deepening economic recession/depression, there will be even less resources available to combat it in the future.

As always - let the buyer beware!

Military fails on brain-test follow-ups

Given our mini-seminar on Traumatic Brain Injury at our AOCOPM Spring Mid-Year meeting, I thought this article in Monday's USA Today might be of interest: Military fails on brain-test follow-ups

Understanding Insurance: Will a Public Option or Co-op Get US Where We Want?

Today's commentary comes from an article I'd written for the Journal of the American Osteopathic Association and published today. Please click here.

Medicare SGR Update

The Senate passed HR 4851, the Continuing Expansion Act of 2010, this evening preventing the scheduled Medicare cut until June 1, 2010. The bill was passed in the House before the Spring recess with an effective date through  May 1, 2010. The Senate bill is being sent back to the House for approval to reconcile of the dates. It is expected to pass this week.

Opportunity Forfeited by National Physician Groups

Today, the Senate is expected to vote on HR 4851, the Continuing Expansion Act of 2010. It will maintain Medicare payments on the level prior to the 21.3% cut which occurred April 1, 2010 because Congress has not yet permanently fixed the Medicare Sustainable Growth Rate (SGR) formula. Until now, CMS has been holding claims payments hoping for another Congressional fix; but the agency can only hold claims for 10 business days and must begin payments on April 15. If Congress approves this billl, it will kick the proverbial can down the road for another month, with another fix needed on May 1, 2010.

The question is why would our national physician organizations endorse a supposed comprehensive health reform plan that did not assure that physicians would be able to afford to continue to provide services to their patients? Did they not understand who their members are and that this is not a fiscally feasible business model for physicians? Why would such powerful organizations, with lawyers on staff, give up their leverage in bargaining for a permanent SGR fix for a politician's promise to take care of it at a later date? Did they all fail Negotiations 101?

At first, I too, believed that might have been the case, but that is perhaps too easy an answer. In hearing the coments of some of Democratic politicians (who eventually voted again the bill) regarding the arm twisting that went on behind the scenes, I heard one congressman say they were effectively told how lucky they were to even be invited to the table, otherwise they would have been the main course. Funny, I heard the same words from the leadership of one of our national physician organizations at the end of November. Coincidence?

Physicians representing national physician organizations may have been invited to the photo-ops, but at best, they were only give a crumb or two that fell on the floor with offers to study solutions to the malpractice problem. They were cleasrly not invited to the table to find solutions for healthcare delivery. Were they tricked into believing attendence was participation?

Given the Chicago-style politics in Washington today and the Chicago roots of our largest organizations, were they also strong armed? Did they willingly let the wool be pulled over their eyes? Was it Stockholm syndrome? Or perhaps the did fail Negotiations 101...