controversy

a somewhat controversial bill quietly zipped through texas recently. check out this article. i can't say i'm all for the bill. i'll elaborate on why later but i wanted to put up the link so i wouldn't forget.

missing the point

this is crazy. there was a recent meeting at the white house consisting of "stakeholders" in the debate to lower healthcare costs. here's a link to the people who showed up to the meeting. what group is noticeably missing? how about representatives from the american bar association? i would have liked a commitment from their members to not file frivolous lawsuits against physicians but that will never happen. obama doesn't have the guts to call his own people out on it either. don't get me wrong, i know we need lawyers and there are plenty of good ones out there but isn't this a huge piece of the puzzle as to why healthcare costs are so high?! many physicians practice defensive medicine, ordering too many tests they feel they probably don't need but are afraid of missing some rare problem that can get them into trouble. and when that one-in-a-million problem occurs or the patient is the one to blame for a certain problem, bam! lawsuit. unbelievable. with socialized medicine, missed diagnoses will likely increase in frequency because not everyone with foot pain is going to be able to get an mri. plus you'll have limited access to life-saving therapies. here's a nice opinion in a recent wsj.

thank ye

props to my colleagues at the acp internist blog. i've been linked on their site (see under sept 29 post). recently i came across their "medical news of the obvious" posts and found them very entertaining. i have to say, they took an idea i'm sure many of us have had but actually put it to print. i come across a lot of articles in my weekly perusings and a number of them come to such obvious conclusions, i wonder why someone actually spent time and money to publish it. maybe that's the point, to get their name in print. heck, let's be honest, i'm mostly jealous!

"never" events

well, this is october 1. another day, another month you say? not quite, today marks the day that cms (center for medicare and medicaid services, responsible for the largest share of and policy directing physician payments) will stop paying for "never" events. what are these? these are events that in the mind of cms, they/we/the government will not pay for since they feel if proper measures are taken, they would never occur in the hospital. see among many others this site to list the events.

certainly, improved quality in the hospital has to start somewhere but to all of a sudden deny payment seems a little drastic. okay, i can understand that they wouldn't pay for complications related to a severe reaction from a blood transfusion. that is usually due to a clerical error. i can even understand that if a surgeon operated on a patient and left an instrument inside accidentally, there would not be payment to cover treatment for those complications. however, some events, no matter how vigilant or good the treatment, cannot be prevented 100%. for example, a deep vein thrombosis or pulmonary embolism (which i will discuss in a later post) after knee or hip surgery is not a completely preventable event. even if the surgeons use proper medication to prevent these clots from forming, the fact is, the medications are not 100% effective! somehow this obvious fact has escaped the mind of cms. well, more on that later. i need to eat some ice cream and go to bed.