Category: Medical Practice

PHYSICIANS/PHARMA/TECH: A take on the news, sort of

Things we already knew:

Doctors are poor at judging their own abilities. It’s a bit like everyone says they’re a good driver, but that 75% of drivers are terrible.

Merck earnestly believes that it was as pure as the driven snow over Vioxx and never knew that it was dangerous until it took it off the market(who knew about Dodgeball, eh — let alone what Kaiser knew several months earlier).

Little girls don’t really cry tears of stone

Things that I don’t think we did know

Online PHR use is up to 7% by July. Which is about 6% higher than they said it was 2 years ago.

According to the survey, commissioned by UnitedHealth Group and conducted by Harris Interactive ® , only 7 percent of U.S. adults use online personal health records and 35 percent of people surveyed were not even aware this resource technology exists.

PHYSICIANS: Ed Goldman podcast transcript

This is the transcript from the interview/podcast I did with Ed Goldman from MDVIP a week or so back. (The transcript was done very well and very affordably by castingwords. I just gave it a light readability edit)
Matthew Holt: So this is Matthew Holt from the healthcare blog and I’m doing yet another podcast and this one is from Ed Goldman president and CEO of MDVIP. MDVIP is a concierge physician franchise company which is helping physicians setup in the concierge market. Ed is it correct to say you’re a retired physician or are you still practicing?

Ed Goldman: No I’m a full time administrator these days.

Matthew: Ed has crossed over to the dark side but is doing something that is very interesting. Those of you who have read the healthcare blog know I’m not a big fan of multi different tiers of medicine—I’m all for universal health insurance and all the rest of it. You may wonder why I’m featuring someone from the “other end”. The reason is I had a conversation with Ed a while back in doing some private consulting work. There were some really interesting outcomes and approaches that MDVIP is using. So Ed a) thank you very much for agreeing to coming on the podcast and b) why don’t you give me a touch about the background of MDVIP how you work with physicians where you are as an organization and a little bit about how you got into this just a little bit of introduction I don’t know much about the company. 


Continue reading…

PHYSICIANS: Patient comments on overuse

The NY Times asked. Have you ever suspected that a physician had financial incentives for recommending a medical treatment to you? One day later they have 236 comments from readers. almost all uniformly going after doctors and dentists for overtreatment.  If you think some TCHB regulars are susicious of doctors…well they’ve got nothing on this bunch!

Meanwhile I have a gem of a story about psychotherapists overcharging desperate parents that I’ve been dragged into which I’ll share with you later.

PHYSICIANS/POLICY: Concierge Medicine-Interview with Ed Goldman MDVIP

Does primary care have a future? And is that future a version of concierge medicine? It’s very early days, but yesterday I had a great conversation with Ed Goldman, CEO of MDVIP, a franchise concierge medicine company. He has some very interesting things to say about how concierge care may not just be for the worried wealthy.

The conversation is in this podcast
There’ll be a transcript available in a couple of days.

PHYSICIANS: The sky is falling

Capitol2Mark McClellan says that Medicare payments to physicians are going down 5%. This of course is leading to political pressure, with the President of the AMA writing op-eds showing that the sky is indeed falling on the heads of seniors. And don’t let any of those pesky researchers at HSC tell you that cuts in Medicare reimbursement actually don’t lead to doctors dropping out of Medicare.

Oh well, perhaps the doctors will make their money back by investing in more specialty hospitals–after all, that moratorium is over. Let the self-referrals begin.

CODA: The AMA Pres uses this sentence "In 2006, Medicare is reimbursing physicians about the same as it was in 2001 — that’s in real terms, not adjusted for inflation." Someone needs to take him to a very basic economics class. "Real" means that it is adjusted for inflation. He means "nominal". And of course someone else needs to explain the P x V = I phenomenon.


PHYSICIANS/POLICY: Where’s the outrage? by Eric Novack

Eric Novack is a bitter, twisted physician (just kidding Eric!)in fact he’s outraged! Why? Apparently he wants to be paid on time and doesn’t want to work for free! Read on:

Where is the outrage? Where are the NY Times editorials? The ACLU? In fact, Novack_sm_1anyone?

On September 22nd, 2006, the government will officially stop sending Medicare payments to physicians. The government has stated categorically that CMS will not be responsible for late charges, interest, or other penalties that could accrue during the payment stoppage. How long will the refusal to pay last? To quote CMS, it will be ‘brief’. It will just last 9 days. Payments will resume on October 2nd, 2006. Read the CMS summary yourself

Why? How could this be? I thought Medicare is the ‘solution’ to our healthcare woes, it just needs some tinkering with more technology and ‘performance incentives’?

The reality is that the much esteemed Medicare system that many THCB aficionados want for everyone is flat broke already. Not in the next 50 years, not for the next generation. Now. In the same way that we think that we will just backdate that check to our landlord, in the same way we just miss one mortgage or car payment by a week or so to wait for the paycheck to register in our account, the government is passing the bill for this year’s Medicare program onto the next year (the beauty of the fiscal year…). Math time: 9/365=2.5% (or 0.0246 for the disbelievers among you) Total Medicare Part B gross estimate (very rough) of $150 billion x 2.5%=$3.75 Billion.

Quite a ‘late check’. Except that the government refuses to pay a late fee. The government says too bad. Perhaps next year the ‘no pay’ period will last 2 weeks? 4 weeks? Perhaps the government will decide to not pay to ‘catch up’ on late payments? It is not a question of if, rather a question of when. Quoting Benjamin Rush at the Constitutional Convention of 1787: “Unless we put medical freedom into the constitution the time will come when medicine will organize into an undercover dictatorship and force people who wish doctors and treatment of their own choice to submit to only what the dictating outfit offers.”

This is a time for courage. The courage of US physicians to remove themselves from the Medicare system as it stands and demand a system that respects the rights of not just the patients of America, but also the providers.

HEALTH PLANS/PHYSICIANS/TECH:Health care, the way it should be (or How to stop worrying and learn to love the bomb), by Pat Salber

Pat Salber writes The Doctor Weighs In. She is a doc, an ex-med director at California blue shield, and a Kaiser Permanente member. And she loves them. This is why, and it’s quite an advertorial for Kaiser and an indictment of how everyone else does it. So if this becomes the standard, and people find out about it (and with $80m of advertising budget a year behind it, they will find out) can the rest of the US system compete?

Health care, the way it should be or  (How to stop worrying and learn to love the bomb)


I have to tell you again about what great health care I get from Kaiser Permanente Northern Cal. Drhealth (Yeah, I know, they screwed up on the transplant service).  But, they are doing a lot of the things we, the wonks, have been hollering about for years.  Read this.

Sunday night I noticed new “floaters” in the right visual field of my right eye.  They were different from the run of the mill floaters – those little dark circles — most of us have.  These were like long lines and they only moved on the right side of the visual field.  The next day, I started having sparkling lights, again in the right visual field.  Now, even an emergency physician knows this could indicate a retinal detachment (serious indeed).  So mid-afternoon, when I had convinced myself it would be stupid to miss my own diagnosis, I called KP.  The woman on the phone in the opthalmology department clearly had been trained.  When I talked about the sparkles, she put me on hold and got a nurse. 

The nurse tried her best to get me in the same day.  She had an appointment available, but being rush hour, there was no way I could make it. She carefully went over the symptoms of retinal detachment and compared them to what I was experiencing.  Together we decided it was OK to wait until the next am for an appointment.  She carefully explained that if certain symptoms occurred (e.g., a sensation of a curtain coming down over the eye), that I needed to go to the emergency department right away as that could indicate a retinal detachment.

The next day (today) I showed up at the opthalmology department.  The receipt I was given for my $15 co-pay listed the dates I had had all of my age/gender specific  preventive services and the dates the next ones were due.

There was no wait to see the doctor.  I was put in an eye exam room and saw a nurse right away.  She explained everything she was going to do.  She anesthetized my corneas,  she tested my vision (with glasses and with pinholes), she used the slit lamp to look at the corneal surface, and then she put in drops to dilate my eyes.

After about 15 minutes (waiting for the eyes to dilate), Dr. Prusiner, chief of the department came in to see me (he is the brother of Stan Prusiner, the Nobel Prize winner who discovered prions).  He did a very thorough exam of both retinas using a variety of techniques.  He explained that I had a vitreous detachment (annoying, but otherwise, no big deal).  He showed me a color picture of an eye with a vitreous detachment.  He answered all of my questions.  He did  not seem rushed (because the nurse had done a lot of the early work for him).

We were finished, he gave me a  4 x 6 piece of paper with his name, his photo and the URL of his home page.  Here’s the link  so you can see how nice it is.  This is, I think, the new KP Connect.  It also showed all of the stuff (by major categories) that he had on his home page.  He wrote down the diagnosis “vitreous detachment” on the paper and drew an arrow from it to name of the link where I would find the information he had chosen for his patients to read about this condition. He urged me to read it.  I went on the site, found the condition, and, lo and behold, everything he told me was what was on the site.

He then told me, in detail, what symptoms would require me to call or go to the ER right away.  But he assured me that the symptoms represented complications highly unlikely to occur.

By the way, he said as I was leaving.  Be sure to make an appointment with the optometrist.  I think we can improve the correction of your left eye.

I challenge you to find one single thing you would want that I didn’t get.  This is the way health care should be.


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