Our favorite health care economist, Jason Shafrin, hosts next week's CavRisk. Entries are due by Monday (the 8th).
NB: We're now using this submission tool: The BC WorkAround
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Friday, August 05, 2011
Thursday, August 04, 2011
Survey says: LTCi on the rise
Got an email the other day from Broker World magazine [motto: "You really don't want to see our swimsuit issue"] announcing that they'd published "the industry's most comprehensive Individual Long Term Care Insurance Survey." This was, in fact, the 13th consecutive such polling. My interest piqued, I asked for (and received) a .pdf copy of the article for review. Details on how you, too, can get a copy are at the conclusion of this post.
In the event, I turned to our resident LTCi guru, Herman Bruns, for assistance in noodling through the article (which ran to 28 pages). We were primarily interested in the first 8 or so, which digested and analyzed the results, which were based on the responses of the 18 carriers which participated (out of only 25 companies that market LTCi in any serious way). The results were interesting, but there were only a few real "surprises."
First, overall sales of LTCi increased last year; it's estimated that the industry sold about 6% more policies than in 2009, with a corresponding 10% increase in premium dollars. This tracks with our own experiences: as Boomers (and immediate pre-Boomers) hit their senior citizenship, there's an increased awareness of the need for these plans.
Claims data was even more interesting: total claims hit over two-and-a-half billion dollars. Of these, home health care (and adult daycare) accounted for about 40%, nursing home care a tad under that, and assisted living facility-related claims came in under 25%.
One reason cited for the near-equal distribution of home health and nursing home claims is the large number of older policies, which typically pay only for the latter; as these "age off" the books, look for that distribution to be more home health-weighted.
We're big fans of the Partnership Program; the study found that, had this program been fully implemented in all 58 states, over two-thirds of the plans sold would have been Partnership compliant.
We're not such big fans of the newly-minted CLASS Act, but the article claims that it's "stimulating workplace sales" as more front-line workers become aware of the importance of long term care coverage. This may also explain the apparent shift toward less expensive product designs (no doubt underscored by John Hancock's recent, and highly publicized, rate increase on many existing plans).
Herman and I were both rather startled by this chart:
In the event, I turned to our resident LTCi guru, Herman Bruns, for assistance in noodling through the article (which ran to 28 pages). We were primarily interested in the first 8 or so, which digested and analyzed the results, which were based on the responses of the 18 carriers which participated (out of only 25 companies that market LTCi in any serious way). The results were interesting, but there were only a few real "surprises."
First, overall sales of LTCi increased last year; it's estimated that the industry sold about 6% more policies than in 2009, with a corresponding 10% increase in premium dollars. This tracks with our own experiences: as Boomers (and immediate pre-Boomers) hit their senior citizenship, there's an increased awareness of the need for these plans.
Claims data was even more interesting: total claims hit over two-and-a-half billion dollars. Of these, home health care (and adult daycare) accounted for about 40%, nursing home care a tad under that, and assisted living facility-related claims came in under 25%.
One reason cited for the near-equal distribution of home health and nursing home claims is the large number of older policies, which typically pay only for the latter; as these "age off" the books, look for that distribution to be more home health-weighted.
We're big fans of the Partnership Program; the study found that, had this program been fully implemented in all 58 states, over two-thirds of the plans sold would have been Partnership compliant.
We're not such big fans of the newly-minted CLASS Act, but the article claims that it's "stimulating workplace sales" as more front-line workers become aware of the importance of long term care coverage. This may also explain the apparent shift toward less expensive product designs (no doubt underscored by John Hancock's recent, and highly publicized, rate increase on many existing plans).
Herman and I were both rather startled by this chart:
The top two carriers held 54% of the market; both of us expect this to change as the aforementioned John Hancock reaps the results of its rate hike (which is not to say that it was unjustified, or even necessarily a "bad thing"). But what really had us scratching our heads was who held the #3 slot: Northwestern Mutual. This carrier, while financially solid as a rock, is not known for price competitiveness, and we marveled at its much-higher-than-expected results.While it's tempting to label LTCi as "insurance for old people," the average issue age continues to hover at around 58 - not exactly ancient. That makes sense, of course: one's old enough at that point to have accumulated enough assets to be worthwhile protecting, yet young enough that the premiums aren't a huge drag.
Finally, the buyers' "gender gap" was surprising:
"58 percent of buyers are women, but 71 percent of single people who buy are female."
This makes sense, as well: like it or not, there's a much greater likelihood that a widow's going to need long term care than a widower (lot's more of 'em).
Obviously, there's a lot more information in the article itself:
"The complete findings have been published in Broker World Magazine's July 2011 edition. To receive a free, no obligation subscription to Broker World Magazine, compliments of DAI, please click here."
[Hat Tip: Dean Dumond]
What Were They Thinking?
A few weeks ago, physicians were once again faced with the possibility of Medicare Cuts based on the Sustainable Growth Rate (SGR) - that was adopted in the Balanced Budget Act of 1997. Since the SGR went into effect, each year physicians are threatened with a pay cut from Uncle Sam. This time it is close to 30% for year 2012.
However, now we have the Debt Deal, which changes the game AGAIN. In the past years, Congress has either let the cuts go into effect and then rescinded them after the New Year or simply stalled the cuts for days, weeks, months, or the next year, without fixing the policy that determines how physicians are paid. But now the government has decided that it is best to penalize physicians:
There are so many things wrong here, where to begin:
Reality One: People are living longer, into their late 70’s and early 80’s. With Medicare enrollment at age 65, a person could conceivable be on Medicare for 20 years.
Reality Two: The majority of healthcare spending is at the end of life.
Reality Three: Payments to physicians have not changed significantly for over a decade. That includes all payments from all insurance companies, not only Medicare, because commercial insurance companies base their payments to physicians from the Medicare Fee Schedule.
Reality Four: America is facing a physician shortage.
My own practice is booked out for new patients 8 weeks and it usually takes an established patient at least two weeks to get in to be seen. We have increased our hours to accommodate more patients; however, the demand is greater than the supply. In a normal capitalist business, a greater demand would drive up prices, and profits, which would entice more people to get into that business, thus alleviating the demand and meeting the needs of the people. However, the government regulates how much physicians are paid through the Medicare Fee Schedule
Let’s review the purpose of Medicare: To provide Healthcare Insurance for the elderly so that they can continue to have access to healthcare professionals after they retire and, in theory, lose their employment based Healthcare Insurance. However, it that Insurance has determined that it will cut what it pays to physicians, then physicians will not be available to service the population that Medicare professes to want to help.
Reality Five: By sparing beneficiaries the reality of the cost of healthcare, the government is also sparing them the ability to see physicians, because physicians will close their doors to Medicare Patients.
In conclusion: The government cannot balance the budget on the backs of our physicians.
Health Wonk Review - Heat Wave edition
HWR co-founder Joe Paduda hosts this week's outstanding collection of insightful, yet wonky, health care-related posts.
Wednesday, August 03, 2011
Medicare Hospital Penalties
Medicare is monitoring hospital readmissions and they are not happy. Georgia Seniors on Medicare need to know their rights when they are admitted, and then readmitted to the hospital for the same medical condition.
If Medicare get's their way, hospitals could be held financially responsible for seniors on Medicare that may have been discharged too soon.
In an effort to save money and improve care, Medicare, the federal program for the elderly and disabled, is about to release a final rule aimed at getting hospitals to pay more attention to patients after discharge.
A key component of the new approach is to cut back payments to hospitals where high numbers of patients are re-admitted, prodding hospitals to make sure patients see their doctors and fill their prescriptions.
Medicare also wants to pay less to hospitals with higher-than-average costs for patient care. It has proposed calculating the costs by combining a patient’s hospital expenses with fees incurred up to 90 days after discharge.
In other words, if Medicare decides you were discharged too early the HOSPITAL, not Medicare, will be responsible for covering the cost of your care.
Medicare states that hospital readmissions cost Medicare about $26 billion over a 10 year period.
Now $26 billion might seem like a lot of money to you and me but Washington loses that much change in the sofa on a weekly basis.
Medicare’s penalties could be significant — and widespread. Almost 7 percent of acute-care hospitals — 307 out of 4,498 — had higher-than-expected re-admission rates for heart failure, heart attack or pneumonia, according to Medicare data. Under Medicare’s draft proposal, which it put out in May, penalties would start in October 2012 and hospitals with the worst re-admission rates eventually could lose up to 3 percent of their regular Medicare payments.
Hospitals with patients who cost Medicare lots of money during and after their hospital stays also could be hurt. Beginning in October 2013, these spending levels would count for a fifth of Medicare’s “value-based purchasing program,” which alters hospital payments based on a long list of quality measures.
This does not look good for Medicare beneficiaries either.
“The incentives we’re putting into place have created a whole new way to think about hospital care,” said Jonathan Blum, deputy administrator of the federal Centers for Medicare and Medicaid Services (CMS).
Absolutely. Consider the following "new ways" to thnk about hospital care.
- Sorry, you are too sick, we can't admit you.
- For THAT condition the hospital across the street is a better choice.
- If we admit you and you return it is going to cost us money. Guido will make sure you never again have any complaints about your condition.
- You are well enough to go home now so we will just go ahead and pull the plug. The orderly will be around in an hour or so to roll you out.
- We no longer treat sick patients on Medicare. Come back when you have cash.
OK this might be a stretch but rationed health care wears many faces.
“The more hospitals realize they’re going to be held accountable, that’s where they are going to get creative,” Patel said.
That's a mouthful.
Medicare was never designed to cover all the cost of a hospital stay. The current Medicare Part A deductible is $1132 per admission for the first 60 days. If the hospital is not found liable for an early discharge, who pays?
Or if the hospital appeals the charge that they should be liable for any readmission, who pays until the appeal process is complete?
The answer could be that YOU pay.
How much money do you have in your bank to cover one or more readmissions?
Another sip of COLI
Also known as 'Dead Peasant Insurance," we last considered corporate Owned Life Insurance (COLI) plans almost 5 years ago, when we reported on their (apparent) demise. It seems, though, that George Romero must have been a life insurance mogul, because COLI plans are back in the news:
"Some state insurance regulators are looking into the idea of allowing tax-free exchanges of corporate-owned life insurance policies"
The problem arose out of the solution. That is, just because one couldn't sell new COLI plans, old ones didn't just fade quietly away. They stayed on the books (generating premiums and claims), but with little incentive to do much else with them. Some companies, looking at the cash values of these plans, recognized a treasure-trove of cash sitting idly by. In fact, some of these plans were beginning to self-destruct, as the internal costs ate up the cash build-up.
What to do?
One alternative is to roll the existing, poorly-performing policy into a new, presumably better-performing one. The problem is that old standby, "insurable interest." In this case, it's a legitimate concern, "because a COLI policy may insure former employees as well as current employees, and the employer may have difficulty re-establishing insurable interest on all lives covered by a COLI policy."
Not to mention medical insurability issues, but that's not addressed in the article.
So far, it's all talk, but we'll keep an eye out for any resolution (and any zombie life policies).
"Some state insurance regulators are looking into the idea of allowing tax-free exchanges of corporate-owned life insurance policies"
The problem arose out of the solution. That is, just because one couldn't sell new COLI plans, old ones didn't just fade quietly away. They stayed on the books (generating premiums and claims), but with little incentive to do much else with them. Some companies, looking at the cash values of these plans, recognized a treasure-trove of cash sitting idly by. In fact, some of these plans were beginning to self-destruct, as the internal costs ate up the cash build-up.
What to do?
One alternative is to roll the existing, poorly-performing policy into a new, presumably better-performing one. The problem is that old standby, "insurable interest." In this case, it's a legitimate concern, "because a COLI policy may insure former employees as well as current employees, and the employer may have difficulty re-establishing insurable interest on all lives covered by a COLI policy."
Not to mention medical insurability issues, but that's not addressed in the article.
So far, it's all talk, but we'll keep an eye out for any resolution (and any zombie life policies).
Tuesday, August 02, 2011
Rewarding Customer Service
Several years ago, I received as a gift a "gently-used" Sirius satellite radio, which I've rather enjoyed. The monthly fee is reasonable, although it basically follows the cable-tv model: 350 channels available, and I only listen to 2 or 3 (guess which kind?).
For the past two months, reception has been spotty; at first, I thought it was clouds or sunspots, but after checking with customer service, we eventually determined that the unit was reaching the end of its useful life, and needed to be replaced.
I'm on a month-to-month plan, and I have a unit that's "semi-permanently" mounted in the car [ed: "semi-permanently?" Isn't that like "sort of pregnant?"]. I was looking for a similarly configured unit to replace it.
Poking around the Sirius web-site, I found just the thing: a Stratus 6 (speaking of clouds). Priced at $50, it seemed a good choice. But when I clicked on it to order, I was told that it required that I switch to a 3-month payment plan, which I didn't want to do (if I chose "no subscription," the price jumped to $70!). I also felt that, as a long-time customer, the $15 "activation" fee needed to be waived.
So I called 'em up.
I spoke with "David," a very nice young man who tried very hard to meet my demands. He had no issues with waiving the activation fee, but told me that there was no way he could sell me the radio at the $50 price point if I insisted on staying with the monthly service plan.
At that point, I explained that, having lived the better part of two months without the service at all, I was prepared to just cancel and walk away altogether. But David was tenacious, and came up with a wonderfully creative solution that made everyone happy. He would keep me on the monthly plan, but give me a $20 credit on my account, to make up the difference. He then offered to credit the $4.89 sales tax on the new unit to my account, as well This was a terrific demonstration of outside-the-box thinking, and a true to commitment to great customer service. The new radio is on its way, and I am, in fact, a very happy customer.
Kudos, Sirius!
For the past two months, reception has been spotty; at first, I thought it was clouds or sunspots, but after checking with customer service, we eventually determined that the unit was reaching the end of its useful life, and needed to be replaced.
I'm on a month-to-month plan, and I have a unit that's "semi-permanently" mounted in the car [ed: "semi-permanently?" Isn't that like "sort of pregnant?"]. I was looking for a similarly configured unit to replace it.
Poking around the Sirius web-site, I found just the thing: a Stratus 6 (speaking of clouds). Priced at $50, it seemed a good choice. But when I clicked on it to order, I was told that it required that I switch to a 3-month payment plan, which I didn't want to do (if I chose "no subscription," the price jumped to $70!). I also felt that, as a long-time customer, the $15 "activation" fee needed to be waived.
So I called 'em up.
I spoke with "David," a very nice young man who tried very hard to meet my demands. He had no issues with waiving the activation fee, but told me that there was no way he could sell me the radio at the $50 price point if I insisted on staying with the monthly service plan.
At that point, I explained that, having lived the better part of two months without the service at all, I was prepared to just cancel and walk away altogether. But David was tenacious, and came up with a wonderfully creative solution that made everyone happy. He would keep me on the monthly plan, but give me a $20 credit on my account, to make up the difference. He then offered to credit the $4.89 sales tax on the new unit to my account, as well This was a terrific demonstration of outside-the-box thinking, and a true to commitment to great customer service. The new radio is on its way, and I am, in fact, a very happy customer.
Kudos, Sirius!
Grand Rounds is up!
Dr James Logan hosts this week's collection of interesting (and often thought-provoking) medblog posts.
Monday, August 01, 2011
The Lighter Side: 9 Reasons Why You Should Fire Your Broker
From FoIB Chad:
9. He named his first daughter Erisa.
8. He thinks AD&D coverage requires the participation of a Dungeon Master.
7. She took a correspondence course to be a lawyer but just missed passing the bar exam because she didn't know how to make a mojito.
6. She thinks STD isn't a problem as long as you get a penicillin shot right away.
5. He would rather wear a tinfoil fedora than purchase alien abduction insurance from Lloyd's.
4. He thinks Inland Marine insurance is what you buy for your BassTracker.
3. She recommends prize indemnity insurance just in case you don't win the Powerball next week.
2. She thinks Excess and Surplus lines is primarily for fat people.
And the number 1 reason you should fire your broker. . . .
1. He thinks Health Care Reform was about health, care or reform.
9. He named his first daughter Erisa.
8. He thinks AD&D coverage requires the participation of a Dungeon Master.
7. She took a correspondence course to be a lawyer but just missed passing the bar exam because she didn't know how to make a mojito.
6. She thinks STD isn't a problem as long as you get a penicillin shot right away.
5. He would rather wear a tinfoil fedora than purchase alien abduction insurance from Lloyd's.
4. He thinks Inland Marine insurance is what you buy for your BassTracker.
3. She recommends prize indemnity insurance just in case you don't win the Powerball next week.
2. She thinks Excess and Surplus lines is primarily for fat people.
And the number 1 reason you should fire your broker. . . .
1. He thinks Health Care Reform was about health, care or reform.
DDDUUUHHH
Hank recently posted a short blog with a headline that stated the obvious as if it was new information. I have one to add to his list, “Physicians compensated for volume, not quality.”
Really, is this news to anyone? All medical professionals bill using the “Current Procedural Terminology” Handbook; known in the field as CPT codes. The middle name is Procedure, i.e. what you did, not the “Current Outcome Terminology” handbook. Since a physician is paid based on what he does, then he needs to have many procedures in a day in order to make money. He does so by doing more procedures, seeing more patients: volume is the name of the payment game.
Really, is this news to anyone? All medical professionals bill using the “Current Procedural Terminology” Handbook; known in the field as CPT codes. The middle name is Procedure, i.e. what you did, not the “Current Outcome Terminology” handbook. Since a physician is paid based on what he does, then he needs to have many procedures in a day in order to make money. He does so by doing more procedures, seeing more patients: volume is the name of the payment game.
Friday, July 29, 2011
Diabetes: Some Good News
Those who suffer from this debilitating and often deadly disease may be in line for some good news for a change. FoIB Holly R sent me links to two potentially wonderful breakthroughs.
First up:
"Surgeons at NewYork-Presbyterian Hospital/Columbia University Medical Center are innovating new ways to treat diabetes using techniques from weight-loss surgery"
There's a sort of "d'unh!" moment here: morbidly obese folks tend to be more prone to developing diabetes. But this technique is sort of the obverse side of the coin, in that the doc's are using treatments that were originally designed to treat weight gain and pointing them at the diabetes itself.
The folks at NY-P/C are looking to use a procedure called "sleeve gastrectomy" to target a side-effect of diabetes, astroparesis. They're also "offering weight-loss surgery for the treatment of Type 2 diabetes as part of an ongoing clinical trial."
So far, things look promising.
Half a world away, Israeli researchers have developed "[a]n implantable gastric stimulator with electrodes attached through laparoscopic surgery to the outer stomach muscles." Basically, it's a little "teaser" that both fools you into thinking you're already full, and promotes the release of certain hormones that suppress your desire for just one more Big Mac.
They've already implanted to little widget in over 200 people around the globe, and seen that "the system reduces blood glucose levels significantly."
Very cool.
First up:
"Surgeons at NewYork-Presbyterian Hospital/Columbia University Medical Center are innovating new ways to treat diabetes using techniques from weight-loss surgery"
There's a sort of "d'unh!" moment here: morbidly obese folks tend to be more prone to developing diabetes. But this technique is sort of the obverse side of the coin, in that the doc's are using treatments that were originally designed to treat weight gain and pointing them at the diabetes itself.
The folks at NY-P/C are looking to use a procedure called "sleeve gastrectomy" to target a side-effect of diabetes, astroparesis. They're also "offering weight-loss surgery for the treatment of Type 2 diabetes as part of an ongoing clinical trial."
So far, things look promising.
Half a world away, Israeli researchers have developed "[a]n implantable gastric stimulator with electrodes attached through laparoscopic surgery to the outer stomach muscles." Basically, it's a little "teaser" that both fools you into thinking you're already full, and promotes the release of certain hormones that suppress your desire for just one more Big Mac.
They've already implanted to little widget in over 200 people around the globe, and seen that "the system reduces blood glucose levels significantly."
Very cool.
Nine Signs You Should Fire Your Patient
This post is a response to the article 9 Signs You Should Fire Your Doctor.
A doctor keeping a patient that is medically non-compliant, or who displays unacceptable behavior, may seem the easier path to tread, but actually such patients are a detriment to one's medical practice as well as a malpractice suit waiting to happen. Here are nine signs that it’s time to fire your patient.
1. You don’t mesh. In today’s contentious legal atmosphere it is important that you have a patient that will listen to and take your medical advice and recommendation. As payments to physicians move from fee for service to payment on outcomes it is even more important that your patient follow your medical instructions. If there is a mismatch, then it's in your best interests to sever the relationship.
2. The patient doesn’t respect your time. How many times have you opened the exam room door to a patient on the cell phone asking you to wait for them to finish the phone call? Or, you have checked your schedule and your patient waltzes in 14 minutes late and still expects to be seen, regardless of the fact that there are other patients to be seen? If your patient does not want to take the time to listen to your medical advice but instead only wants some meds so he can leave, that is a problem. If your patient’s chronic lateness is disrupting the office why keep the patient?
3.The patient keeps you in the dark. A patient should be open and thorough about why he has come to see the physician. A physician learns many facts and techniques, however, mind reading is not found in any medical curriculum. A patient endangers himself when he does not reveal his entire medical history at the first appointment. Without proper medical information, a physician could prescribe a medication that interacts negatively with another medication or prescribe a treatment that would not be as effective if all medical information was known. Your medical practice is too important to feel confused or uninformed.
4.The patient doesn’t listen. Does your patient answer your questions with enough information to make a medical decision? When you ask for medical information does the patient jump to a conclusion about what you want to hear instead of providing you the facts? It all comes down to communicating to the patient and ensuring that the patient fully comprehends the information you are giving.
5.The patient is rude to the office staff. The receptionist is the link between you and the patient. As a physician, you put time and effort into ensuring that your staff is professional, trained and has the correct skill sets to manage both your office and your business. As medical professionals, your staff expects to come to work each day and be treated with the respect that matches their job, education, and experience. Even if your patient is pleasant with you, if the patient is rude to your staff this is a signal that you need to ask your patient to look elsewhere.
6.You don’t feel comfortable with the patient or wonder about his competence. As a doctor you need to know intimate details of your patient’s life in order to offer proper treatment. If the patient is not comfortable sharing this information, this hinders your ability to adequately treat the patient and opens you up to malpractice. A sense of unease as to whether or not the patient will follow you directions is a perfectly legitimate reason for cutting the cord. Beware of sloppy medical decision-making on the part of your patient since mistakes and misinformation in the chart can lead to a malpractice suit.
7.The patient does not coordinate his care with other doctors. As a specialist, the patient’s primary care doctor should be the quarterback of his healthcare team. If the patient does not share with you his primary care physician or does not inform his primary care physician of his treatment with you, then an important piece of your care could slip through the cracks.
8.The patient is unreachable. A good patient always ensures that the physician can reach him in the event of an emergency. If the patient is argumentative over providing correct demographic information or refuses to do the yearly demographic form, then you as the physician are missing a vital piece of that patient’s information. As important as your patient is in your care, it is also important that the patient realize that when the office is closed and they are having a medical emergency, the best place for them is the emergency room or urgent care center. As a physician, your primary duty is general care, not emergency care.
9.The patient is rude or condescending. I attended a workshop many years ago on the proper ways to manage health care information. During that meeting, the speaker asked if we had any Celebrity Patients. I responded no, but a lot of them think they are. Do you have a patient list of CP’s? Does your patient walk away when you are trying to give directions, or simply too important to deal with the policies and procedures of your office. Then it is time to part ways, as this patient will always trivialize both you and your staff.
The article does not have an ending paragraph, but I will include one:
Healthcare is one of the most stressful, busy, and under paid career fields that one can enter. People who enter the healthcare field do so not merely for money, but because of a true empathetic and sympathetic calling to help their fellow man. Many times, this character trait is taken advantage of by people who truly believe that they are the center of the universe. As empathic/sympathetic people, it is in our nature to try to make things right. However, since we are all truly mortal, sometimes things cannot be made right.
The article discusses abrupt behavior by physicians. I do concede that physicians can be abrupt at times; however, it is often due to the amount of information that they must process during the average appointment. The physician is the master of multi-tasking: listening, talking, taking notes, and making decisions very quickly and efficiently. While I am not dismissing the attitudes of physicians, as a patient you need to remember you are seeking a physician for his medical expertise, not as your personal confessor, confidant, or even close friend, but as a professional in the medical field that can treat and mend your injuries and illnesses.
A doctor keeping a patient that is medically non-compliant, or who displays unacceptable behavior, may seem the easier path to tread, but actually such patients are a detriment to one's medical practice as well as a malpractice suit waiting to happen. Here are nine signs that it’s time to fire your patient.
1. You don’t mesh. In today’s contentious legal atmosphere it is important that you have a patient that will listen to and take your medical advice and recommendation. As payments to physicians move from fee for service to payment on outcomes it is even more important that your patient follow your medical instructions. If there is a mismatch, then it's in your best interests to sever the relationship.
2. The patient doesn’t respect your time. How many times have you opened the exam room door to a patient on the cell phone asking you to wait for them to finish the phone call? Or, you have checked your schedule and your patient waltzes in 14 minutes late and still expects to be seen, regardless of the fact that there are other patients to be seen? If your patient does not want to take the time to listen to your medical advice but instead only wants some meds so he can leave, that is a problem. If your patient’s chronic lateness is disrupting the office why keep the patient?
3.The patient keeps you in the dark. A patient should be open and thorough about why he has come to see the physician. A physician learns many facts and techniques, however, mind reading is not found in any medical curriculum. A patient endangers himself when he does not reveal his entire medical history at the first appointment. Without proper medical information, a physician could prescribe a medication that interacts negatively with another medication or prescribe a treatment that would not be as effective if all medical information was known. Your medical practice is too important to feel confused or uninformed.
4.The patient doesn’t listen. Does your patient answer your questions with enough information to make a medical decision? When you ask for medical information does the patient jump to a conclusion about what you want to hear instead of providing you the facts? It all comes down to communicating to the patient and ensuring that the patient fully comprehends the information you are giving.
5.The patient is rude to the office staff. The receptionist is the link between you and the patient. As a physician, you put time and effort into ensuring that your staff is professional, trained and has the correct skill sets to manage both your office and your business. As medical professionals, your staff expects to come to work each day and be treated with the respect that matches their job, education, and experience. Even if your patient is pleasant with you, if the patient is rude to your staff this is a signal that you need to ask your patient to look elsewhere.
6.You don’t feel comfortable with the patient or wonder about his competence. As a doctor you need to know intimate details of your patient’s life in order to offer proper treatment. If the patient is not comfortable sharing this information, this hinders your ability to adequately treat the patient and opens you up to malpractice. A sense of unease as to whether or not the patient will follow you directions is a perfectly legitimate reason for cutting the cord. Beware of sloppy medical decision-making on the part of your patient since mistakes and misinformation in the chart can lead to a malpractice suit.
7.The patient does not coordinate his care with other doctors. As a specialist, the patient’s primary care doctor should be the quarterback of his healthcare team. If the patient does not share with you his primary care physician or does not inform his primary care physician of his treatment with you, then an important piece of your care could slip through the cracks.
8.The patient is unreachable. A good patient always ensures that the physician can reach him in the event of an emergency. If the patient is argumentative over providing correct demographic information or refuses to do the yearly demographic form, then you as the physician are missing a vital piece of that patient’s information. As important as your patient is in your care, it is also important that the patient realize that when the office is closed and they are having a medical emergency, the best place for them is the emergency room or urgent care center. As a physician, your primary duty is general care, not emergency care.
9.The patient is rude or condescending. I attended a workshop many years ago on the proper ways to manage health care information. During that meeting, the speaker asked if we had any Celebrity Patients. I responded no, but a lot of them think they are. Do you have a patient list of CP’s? Does your patient walk away when you are trying to give directions, or simply too important to deal with the policies and procedures of your office. Then it is time to part ways, as this patient will always trivialize both you and your staff.
The article does not have an ending paragraph, but I will include one:
Healthcare is one of the most stressful, busy, and under paid career fields that one can enter. People who enter the healthcare field do so not merely for money, but because of a true empathetic and sympathetic calling to help their fellow man. Many times, this character trait is taken advantage of by people who truly believe that they are the center of the universe. As empathic/sympathetic people, it is in our nature to try to make things right. However, since we are all truly mortal, sometimes things cannot be made right.
The article discusses abrupt behavior by physicians. I do concede that physicians can be abrupt at times; however, it is often due to the amount of information that they must process during the average appointment. The physician is the master of multi-tasking: listening, talking, taking notes, and making decisions very quickly and efficiently. While I am not dismissing the attitudes of physicians, as a patient you need to remember you are seeking a physician for his medical expertise, not as your personal confessor, confidant, or even close friend, but as a professional in the medical field that can treat and mend your injuries and illnesses.
Thursday, July 28, 2011
Historically High. No, Wait: Historically Low
Do you sometimes (often?) get the feeling that the rocket surgeons in DC have been inhaling again? Take, for example, two emails I received today, just hours apart.
The first one breathlessly exclaims:
"Healthcare spending to reach new heights ... will account for almost a fifth of the nation’s economy by 2020, with government making up almost half of it, Medicare’s actuaries project"
Oh noes, the sky is falling!
Maybe not, as the second one explains:
"Today, the CMS Office of the Actuary released its report on how much the United States spends on health care now and in the future. The report shows a 3.9 percent growth in health spending in 2010 – an historic low."
So which is it?
One possibility is that these actuaries are, in fact, delusional, and that they don't have a clue as to what's really going on, let alone what will happen down the road as ObamaCrap kicks into high gear. While I'm by no means unconvinced that this is the case, a more charitable conclusion is that both reports are accurate.
But how can that be?
Well, we all know the old saw about statistics, and how they can be made to tell whatever story one wishes to hear. So for those who think the sky is, in fact, falling, there's ample evidence that we should be running for cover. On the other hand, those with a more optimistic outlook have plenty to be cheerful about.
As for me, I think it's perfectly obvious where we're actually heading: an aging population, with the chronic and expensive claims that go with it, presages much higher costs; the implementation of ObamaCare© and it's intrinsic rationing will create even greater anguish.
[Hat Tip: FoIB Holly R]
The first one breathlessly exclaims:
"Healthcare spending to reach new heights ... will account for almost a fifth of the nation’s economy by 2020, with government making up almost half of it, Medicare’s actuaries project"
Oh noes, the sky is falling!
Maybe not, as the second one explains:
"Today, the CMS Office of the Actuary released its report on how much the United States spends on health care now and in the future. The report shows a 3.9 percent growth in health spending in 2010 – an historic low."
So which is it?
One possibility is that these actuaries are, in fact, delusional, and that they don't have a clue as to what's really going on, let alone what will happen down the road as ObamaCrap kicks into high gear. While I'm by no means unconvinced that this is the case, a more charitable conclusion is that both reports are accurate.
But how can that be?
Well, we all know the old saw about statistics, and how they can be made to tell whatever story one wishes to hear. So for those who think the sky is, in fact, falling, there's ample evidence that we should be running for cover. On the other hand, those with a more optimistic outlook have plenty to be cheerful about.
As for me, I think it's perfectly obvious where we're actually heading: an aging population, with the chronic and expensive claims that go with it, presages much higher costs; the implementation of ObamaCare© and it's intrinsic rationing will create even greater anguish.
[Hat Tip: FoIB Holly R]
Hips, Knees, Tonsils and the MVNHS©: Oh, my!
Those rascally rationers at the Much Vaunted National Health Service© are on a roll. Not content to deny essential medical care to cancer patients and patients dying in the hallways, they've set their sites on the more mundane.
To wit:
"Hip replacements, cataract surgery and tonsil removal are among operations now being rationed in a bid to save the NHS money."
If memory serves (and it most assuredly does), proponents of ObamaCrap based most of their advocacy on the "fact" that British-style medical "care" delivered excellent care at substantial cost savings compared to our "broken" system.
The truth is: not so much.
Here's a sample of that superior, yet more cost-effective, health care "system:"
■ Cataract operations being withheld from patients until their sight problems "substantially" affect their ability to work
■ Tonsillectomies only to be carried out in children if they have had seven [seven!] bouts of tonsillitis in the previous year
On the other hand, they did get one thing right:
■ Funding has also been cut in some areas for IVF treatment
Paging Dr Berwick!
To wit:
"Hip replacements, cataract surgery and tonsil removal are among operations now being rationed in a bid to save the NHS money."
If memory serves (and it most assuredly does), proponents of ObamaCrap based most of their advocacy on the "fact" that British-style medical "care" delivered excellent care at substantial cost savings compared to our "broken" system.
The truth is: not so much.
Here's a sample of that superior, yet more cost-effective, health care "system:"
■ Cataract operations being withheld from patients until their sight problems "substantially" affect their ability to work
■ Tonsillectomies only to be carried out in children if they have had seven [seven!] bouts of tonsillitis in the previous year
On the other hand, they did get one thing right:
■ Funding has also been cut in some areas for IVF treatment
Paging Dr Berwick!
Wednesday, July 27, 2011
EMTALA vs DIY
It's not clear from this story, but it appears that the gentleman may have benefited from the services of an emergency room under the auspices of EMTALA:
"A 63-year-old American man with a hernia plunged a butter knife into his abdomen to try to fix the problem, and later put a lit cigarette in the wound."
As the young people say, "you're doing it wrong."
But believe it or not, this was the most eye-opening part:
"Lorenz ... was not under the influence of drugs or alcohol."
The good news is that Mr Lorenz "was taken to Los Angeles County-USC Medical Center ... The hospital was expected to perform the surgery to fix his hernia."
Under the care of a professional surgeon, one presumes.
One can't help but wonder, though, if there's a lesson on the effects of ObamaCare© in here somewhere.
"A 63-year-old American man with a hernia plunged a butter knife into his abdomen to try to fix the problem, and later put a lit cigarette in the wound."
As the young people say, "you're doing it wrong."
But believe it or not, this was the most eye-opening part:
"Lorenz ... was not under the influence of drugs or alcohol."
The good news is that Mr Lorenz "was taken to Los Angeles County-USC Medical Center ... The hospital was expected to perform the surgery to fix his hernia."
Under the care of a professional surgeon, one presumes.
One can't help but wonder, though, if there's a lesson on the effects of ObamaCare© in here somewhere.
MLR Revisited
In the law, there's an aphorism that goes "he who is his own lawyer has a fool for a client."
I would argue that as regards insurance, and especially health insurance, "he who is his own agent has a fool for a client."
[Click here for a detailed explication of why this is so. HGS]
Basically, the agent is the interface between the carrier and the client, and serves as both advisor to and advocate for the latter. Over the years, we've recounted countless experiences where agents have helped clients, both large and small, out of a bind.
Remember also that deleting the agent from the equation represents little, if any, real savings: after all, carriers still have to pay for Customer Service (such as it is) and marketing. If anything, I suspect that most agents who ultimately decide to "stay in" will move to a fee-only model, and clients without access to professional advice and advocacy are the ones who will be most hurt.
And that's one of the effects of the Medical Loss Ratio (MLR) provision in ObamaCare©. By mandating a specific disbursement threshold, agents' commissions go away, making it impossible for us to continue servicing existing clients, let alone obtaining new ones.
Of course, that's easy for me to say; after all, I have a vested interest in the outcome. What if I told you, though, that Senator Mary Landrieu (D-LA), who voted for ObamaCare© so that she (and we) could see what's actually in it, is having second thoughts about doing away with us? In a letter to HHS Secretary Shecantbeserious, Ms Landrieu writes:
"(A) certain provision regarding [ObamaCare©]'s MLR requirements is unintentionally* harming an important sector of the small business community - health insurance agents and brokers - and may also harm other small businesses that rely on their services."
[ed: it's far from clear that this was, in fact, "unintentional"]
So, contra Mr Rockefeller, agents do in fact bring value to the table.
But then, we already knew that.
[Hat Tip: FoIB P Paule]
I would argue that as regards insurance, and especially health insurance, "he who is his own agent has a fool for a client."
[Click here for a detailed explication of why this is so. HGS]
Basically, the agent is the interface between the carrier and the client, and serves as both advisor to and advocate for the latter. Over the years, we've recounted countless experiences where agents have helped clients, both large and small, out of a bind.
Remember also that deleting the agent from the equation represents little, if any, real savings: after all, carriers still have to pay for Customer Service (such as it is) and marketing. If anything, I suspect that most agents who ultimately decide to "stay in" will move to a fee-only model, and clients without access to professional advice and advocacy are the ones who will be most hurt.
And that's one of the effects of the Medical Loss Ratio (MLR) provision in ObamaCare©. By mandating a specific disbursement threshold, agents' commissions go away, making it impossible for us to continue servicing existing clients, let alone obtaining new ones.
Of course, that's easy for me to say; after all, I have a vested interest in the outcome. What if I told you, though, that Senator Mary Landrieu (D-LA), who voted for ObamaCare© so that she (and we) could see what's actually in it, is having second thoughts about doing away with us? In a letter to HHS Secretary Shecantbeserious, Ms Landrieu writes:
"(A) certain provision regarding [ObamaCare©]'s MLR requirements is unintentionally* harming an important sector of the small business community - health insurance agents and brokers - and may also harm other small businesses that rely on their services."
[ed: it's far from clear that this was, in fact, "unintentional"]
So, contra Mr Rockefeller, agents do in fact bring value to the table.
But then, we already knew that.
[Hat Tip: FoIB P Paule]
Cavacade of Risk #136: Riskiest Sports edition is up!
Jacob Irwin presents this week's collection of risky posts, all centered on risky sports, from horse racing to cave-diving (and don't miss the cheerleaders!).
Tuesday, July 26, 2011
Weather or not....This is kinda cool [UPDATED]
About two months ago, our little corner of southwest Ohio was treated to a major thunderstorm, complete with "golf ball sized" hail.
As an aside: I had heard the term "golf ball sized hail" before, but never seen it myself. I imagined a roughly 2" diameter sphere. What came from the sky was, in fact, a rather flat piece of ice about 2" in diameter. Very scary.
All the west-facing windows at my office were smashed, and the damage around us was widespread. My brother-in-law was driving home from his son's baseball game and ran smack into the middle of the storm; his windshield was cracked in several places (luckily, there were no injuries).
Now, re-wind that a bit, and consider this: how helpful would it have been to my BIL if he'd had "Live:Wire® HailZone™ data and radar analytics to provide advanced warning of severe hailstorms?" This new program, a joint venture between Progressive Insurance and Weather Central, provides "automatic alerts via text message up to thirty minutes before hailstorms, high winds, or other severe weather."
Currently, this program is available only to Progressive insureds, but don't be shocked when we see the Weather Channel team up with State Farm, or whatever.
Very cool.
UPDATE - MORE COOL (NEW) TECH: Recently, I had some trouble writing a new life insurance policy on a gentleman who was, as we knew upfront, a diabetic. After doing a routine pre-screen, we applied; as part of the process, he had to undergo a brief medical exam. Unfortunately, his A1c "score" came back at 12.3%.
After a bit of Googling, I determined that this was almost twice as high as a "controlled" diabetic; we're still noodling out how to proceed.
But I really didn't know what an "A1c" score actually was or meant, and had to go Googling to find out. Not a huge deal, granted, but still: wouldn't it be nice to have that kind of info at my fingertips? What if I was away from my desk and had no immediate web access?
That's where the "first free mobile app to help consumers decipher their medical tests" comes in. Developed and offered by Lab Tests Online, this little widget "connects consumers to reliable, unbiased information that enables them to have more informed conversations with their doctors."
It seems to me that it would be just as handy as a quick reference for just about any medical test, even when it's just for one's own peace of mind.
As an aside: I had heard the term "golf ball sized hail" before, but never seen it myself. I imagined a roughly 2" diameter sphere. What came from the sky was, in fact, a rather flat piece of ice about 2" in diameter. Very scary.
All the west-facing windows at my office were smashed, and the damage around us was widespread. My brother-in-law was driving home from his son's baseball game and ran smack into the middle of the storm; his windshield was cracked in several places (luckily, there were no injuries).
Now, re-wind that a bit, and consider this: how helpful would it have been to my BIL if he'd had "Live:Wire® HailZone™ data and radar analytics to provide advanced warning of severe hailstorms?" This new program, a joint venture between Progressive Insurance and Weather Central, provides "automatic alerts via text message up to thirty minutes before hailstorms, high winds, or other severe weather."
Currently, this program is available only to Progressive insureds, but don't be shocked when we see the Weather Channel team up with State Farm, or whatever.
Very cool.
UPDATE - MORE COOL (NEW) TECH: Recently, I had some trouble writing a new life insurance policy on a gentleman who was, as we knew upfront, a diabetic. After doing a routine pre-screen, we applied; as part of the process, he had to undergo a brief medical exam. Unfortunately, his A1c "score" came back at 12.3%.
After a bit of Googling, I determined that this was almost twice as high as a "controlled" diabetic; we're still noodling out how to proceed.
But I really didn't know what an "A1c" score actually was or meant, and had to go Googling to find out. Not a huge deal, granted, but still: wouldn't it be nice to have that kind of info at my fingertips? What if I was away from my desk and had no immediate web access?
That's where the "first free mobile app to help consumers decipher their medical tests" comes in. Developed and offered by Lab Tests Online, this little widget "connects consumers to reliable, unbiased information that enables them to have more informed conversations with their doctors."
It seems to me that it would be just as handy as a quick reference for just about any medical test, even when it's just for one's own peace of mind.
Grand Rounds: Good Care edition
The folks at the Prepared Patient Forum host this week's round-up of medblog posts, focusing on what it takes to find good care and make the most of it. Do check it out.
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