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“Choosing Wisely” doesn’t

Back in September, WingRight promoted a program, “Choosing Wisely,” an initiative by the American Board of Internal Medicine. Well, the other shoe dropped.

For years, I’ve told patients that we need to periodically screen for hypertension and diabetes because most people don’t feel bad when their blood pressure or blood sugar is high. The Center for Disease Control reports that about a fifth of people with high blood pressure and that nearly a third of diabetics are undiagnosed.

But these facts didn’t impress the Society of General Internal Medicine, which released their “Choosing Wisely” list suggesting that doctors not ask non-insulin dependent diabetes patients to check their sugars at home or schedule “routine general health checks for asymptomatic adults,” including the ‘health maintenance’ annual visit”  The SGIM claims that these common medical practices cause more harm than good — or is it that they cost more money than they save?

 

 

 

 

 

 

 

Even the CDC is victim to the #ShutDown #TemperTantrum!

Someone was paid to put this notice on the Centers for Disease Control website! On the home page, it’s on a red background! (But don’t worry: they also have a reminder to sign up for ObamaCare.)

Due to the lapse in government funding, only web sites supporting excepted functions will be updated unless otherwise funded. As a result, the information on this website may not be up to date, the transactions submitted via the website may not be processed, and the agency may not be able to respond to inquiries until appropriations are enacted.

Updates regarding government operating status and resumption of normal operations can be found at http://www.usa.gov.

via CDC – Diabetes Public Health Resource – Data & Trends.

Update, 7:30 PM 10/7/13: The National Institutes of Health also has a disclaimer.

The New Face of Prejudice – WSJ.com

Democracy Corps word cloud 10 2013I’ll let you read the translation byJames Taranto’s Best of the Web Today (in the Wall Street Journal) of this little bigoted “memo” against the Republicans, the Tea Party and Evangelicals sent out by “Democracy Corps'”  Stan Greenberg and James Carville on your own ( The “memo” is also available for download online in pdf) , but you probably won’t have too much trouble anticipating it from this excerpt:

We expected that in this comfortable setting or in their private written notes, some [participants] would make a racial reference or racist slur [sic] when talking about the African American President. None did. They know that is deeply non-PC and are conscious about how they are perceived. But focusing on that misses how central is race to the worldview of Republican voters. They have an acute sense that they are white in a country that is becoming increasingly \”minority,\” and their party is getting whooped by a Democratic Party that uses big government programs that benefit mostly minorities, create dependency and a new electoral majority. Barack Obama and Obamacare is [sic] a racial flashpoint for many Evangelical and Tea Party voters.

How could anyone take seriously a memo co-authored by these two men? Especially one that is supposed to explain Republicans, using “word cloud” graphic, featured above? Mr. Taranto didn’t, but found at least one author on Bloomberg who did.

If you aren’t a subscriber, consider signing up for the free daily email from The Best of the Web.

1996: Virgin Islands beach reopened

Judge orders Virgin Islands beach reopened

January 4, 1996

Web posted at: 12:45 a.m. EST

ST. CROIX, U.S. Virgin Islands (CNN) — A federal judge Wednesday ordered the National Park Service to reopen the Buck Island Reef National Monument despite the ongoing federal budget crisis.

Two Virgin Island residents sued in federal district court to have the park reopened, arguing they were being hurt by the closure of the beach at Buck Island. They said the shutdown had denied them the ability of “freely enjoying a cherished natural resource.” They further argued that the Park Service had violated the federal Open Shorelines Act by closing the beach.

The National Park Service argued it had no choice because the budget crisis had forced it to reduce the normal staff of “two to three employees” to one employee and one volunteer.

via CNN – Virgin Islands beach reopened – Jan. 4, 1995.

Feds “own” or “run” too much – Update

Tennessee Smokeys 2 2005It’s not just that this is the first time that US citizens have been barred from the Lincoln Memorial due to a government shutdown, the National Parks service is barring us from  scenic drives and overlooks on public and state highways, open beaches and the waters around them, and private businesses that are paying tenants of “government” lands and waters.

One former Secretary of the Interior, Gale Norton, flatly states that these decisions are political and most likely being made in the White House.

Perhaps, instead of blaming one Party or another (or increasing government involvement in something as vital and intimate as the delivery of medical care), it’s time to decide whether our government is responsible enough to own and control so much of our lands.

Update: more closings

1. The City Tavern in Philadelphia, because the Feds own the building, not the business.

2.Nauset Knoll Motor Lodge, which leases land in Cape Cod National Seashore.

3. All sorts of fishing, rafting and hiking. Search the news on any of these topics – there are too many to post.

4. Government sponsored travel, such as the President’s Asian trip. But it also will block scientific conferences. 

Edited Oct 4, 2013 at 2 PM to change the picture to one that I own.

White House Ordering Hundreds of Privately Run, Privately Funded Parks to Close

The order to shut down business that pay money to the Federal government rather than cost money came from ” ‘above the department’, which I presume means the White House” . . .

“My company, based in North Phoenix, operates nearly over 100 US Forest Service campgrounds and day use areas under concession contract. Yesterday, as in all past government shutdowns, the Department of Agriculture and US Forest Service confirmed we would stay open during the government shutdown. This makes total sense, since our operations are self-sufficient (we are fully funded by user fees at the gate), we get no federal funds, we employ no government workers on these sites, and we actually pay rent into the Treasury.”

via The PJ Tatler » BREAKING: White House Ordering Hundreds of Privately Run, Privately Funded Parks to Close.

Experts Suggest Software Problems, Not Just Demand, May Be Behind Marketplace Glitches – Kaiser Health News

“This is not a glitch. A glitch is a minor problem,” said Robert Laszewski, a consultant and former insurance executive. “The real story is that the Obamacare computer systems simply are not working.”

via Experts Suggest Software Problems, Not Just Demand, May Be Behind Marketplace Glitches – Kaiser Health News.

Special penalties in USVI during shutdown

From that blog post on Obama’s #TemperTantrum:

” However, only one of our beaches is staffed with lifeguards under normal circumstances anyway, and when the Park closes on holidays, beaches are not barricaded, nor are citations issued to beach-goers.  It should also be noted, interestingly, that according to VI Coastal Zone Management Act Section 903 (b) (6), all Virgin Islands beaches are public, from the high tide mark down to the water line…”

There have never been barricades (#Barrycades ) before, but there are under #HarryReidsShutdown?

The Government Shutdown Goes Caribbean

Here’s what’s happening on St. John, US Virgin Islands due to Obama’s temper tantrum. This in spite of the fact that there are few restrooms and lifeguards, normally. (I think 2 of the beaches have lifeguards.) Those mooring balls are spots for boats to tie up – they are self-serve and people put their money ($15 a night) in a drop box on the honor system.

 

JUST BEaching.

St John, USVI, hotbed of #shutdown protest?

So it would seem, however unlikely.

Our fair island is about 70% National Park land.  Our tourism industry depends largely on operations and concessions inside the park – everything from taxi tours to boat charters, from snorkeling trips to beach weddings.  Visitors come from near and far, both domestic and abroad, to sit on some of the most beautiful beaches in the world.  Most of all, people visit for a chance to breathe, relax, and let the rest of the world fall away for a little while.

Yesterday, all of that changed.  When Congress allowed partisan politics to prevent them from reaching an agreement to fund the government, a long list of government programs and agencies were immediately shut down, including the National Park system within the Department of the Interior.  In the Virgin Islands this left some 65 employees furloughed until further…

View original post 660 more words

Shutdown 2013: Furloughed Workers Signing Up As Tourists Guides (Demonstrating in Union shirts)

With the help of AFSCME national and the AFL-CIO’s Washington D.C. Metro Council, the unions created the “Federal Worker’s Guide to Shutdown D.C.,” which gives the status of major points of interest.

The furloughed workers will be in green and blue union t-shirts on the Constitution Avenue side of the Natural History Museum from 10 a.m. until noon on Wednesday. If the shutdown is long and the effort is successful, they may add volunteers at other museums.

Furloughed workers will be carrying signs.

via Shutdown 2013: Furloughed Workers Signing Up As Tourists Guides, Sans Pay – Skift.

Padre Island National Seashore Closes (even the Gulf water!)

How do they justify the extra people to close the WATER around Padre Island?

“Technically, they can’t even fish in park waters, we’ll have rangers on patrol to make sure that people know the waters as well as the land that’s under are jurisdiction is closed,” he added.

via Padre Island National Seashore Closes After Government Shutdown | Corpus Christi, TX | KRISTV.com |.

Nationalization: One step at a time

The people relying on Medicare, Medicaid and Social Security didn’t fail. They (we) were sold a tax scheme (sound familiar, Justice Roberts?) that claimed to be insurance and pension plans.

 

If you’ve ever scoffed at the rumors that the Federal government might confiscate your retirement savings, it’s time to reconsider. And you don’t have to look to the actions of Greece, Ireland, Poland or Cyprus to do so.

I recently read a radical extension of past theories for a Nationalized health care solution to the costs of Medicare and Medicaid for the elderly:  Since many elderly citizens receive more out of Medicare, Medicaid and Social Security than they paid in, and so many eventually rely on Medicaid to pay their bills, it was suggested that our government “nationalize” all Nursing Homes and Assisted Living businesses and confiscate of Senior citizen’s assets. The Feds could then expand the Veterans Administration system in order to provide housing and medical care until death.

 

Isn’t the entire purpose of any insurance a bet that the insured will someday need more than he pays into the fund? Couldn’t the claim be made that many Social Security beneficiaries often receive more money over their lifetimes than they paid into the funds?

Since the Federal government got into the health care business with Medicare, Congress has done everything possible to ensure that Seniors are dependent on what we now know are failures. Everyone who becomes “Medicare eligible” –  turns 65 years old – faces penalties for not signing up with Medicare.  Janet Reno threatened Federal charges and prosecution for any Medicare-eligible senior who dared to pay for their own health care with their own money or entered into “private contracts” with their own doctors. Their doctors faced the penalties that go with “opting out” of Medicare. For anyone planning ahead, Congress wrote laws severely limiting Health Savings Accounts.

In the meantime, Federal (and State) government(s) failed to put money aside for the future of the people who were paying taxes that could have gone into genuine savings or the purchase of real insurance.  Private insurance and pension funds acting the same way would have been shut down and the officers imprisoned for doing the same thing.

Under the “tax” of the ACA, everyone will be forced by law – and the IRS, Federal lawyers, guns and prisons – to buy “insurance” (in reality, pre-paid health care). Since the scheme is rigged to benefit the government-run exchanges, that’s how most will buy their “insurance” – or pay their tax.

When the “Affordable Care” scheme proves to be as false as Medicare and Social Security, what next? Where to stop with “nationalization” and confiscation of property? 401K’s? Private pensions? The family home and Mama’s jewelry?

Edited to clean up punctuation, order of ideas – BBN

Health Exchanges Debut With Websites Down, Delays – Businessweek

The Obama administration needs some breathing room, said Kathleen Sebelius, the HHS secretary, at a briefing with reporters yesterday.

via Health Exchanges Debut With Websites Down, Delays – Businessweek.

Gohmert Refuses to Take Subsidy Others Don’t Get #MakeDCListen

Representative Louie Gohmert (Republican from my old home in East Texas) leads the way: refuse ObamaCare subsidy if you can afford it.

“House Republicans have voted for and sent the Senate two different bills, because we have been offering compromises, even to the extent of compromising with ourselves because Senate Democrats and the President have refused to negotiate at all. They have made clear that they will negotiate with Russians and Iranians, but will not negotiate with Americans.”

via Gohmert Refuses to Take Subsidy Others Don’t Get : U.S. Congressman Louie Gohmert.

ObamaCare isn’t answer for Texas #MakeDCListen

President Obama and all of his appointed Secretaries and czars, most certainly his White House staff, with their high salaries, ought to be forced to accept a “Bronze Plan” on the Federal health care exchange, with either the regular or no Federal subsidy.

While it appears that Obama and the Senate Dems have no intention of compromising, I hope that Republicans win the one year delay – but Health and Human Services Secretary Kathleen Sebellius says ObamaCare will go into effect tomorrow, even if the government shuts down.

ObamaCare is certainly not the answer for my State of Texas. Like the rest of the Country Texans have already started paying increased taxes to pay for a scheme that will help no one until January 1, 2014. Even then, it will hurt many and help very few.

75% of Texans are insured or at least were until this year. They are already worse off under ObamaCare, with higher premiums, higher taxes, and an increased risk of paying taxes on the insurance they do have.

The great majority of uninsured won’t be better off under ObamaCare: a)1/3 to 1/4 of uninsured in Texas are illegal aliens, b) Half of the uninsured in Texas make over $50K a year, c) Texas voters have decided that we won’t expand Medicaid to healthy adults without children who aren’t subjected to any means testing other than annual income.

Senate Dems Sauntering Toward #HarryReidsShutdown #DCtime

Harry Reid is sauntering toward a Federal gov’t shutdown at midnight, tonight.

Even though the House passed a compromise Continuing Resolution (no longer defunding Obamacare, simply delaying it) just after midnight yesterday (Sunday) morning, Harry refused to allow the Senate to gather until 2PM, DC time, today (Monday).

Then, he made his motion to table the House CR. The motion passed along strict Party lines, 54-36. Then . . . might as well wait for it . . .  he announced “debate” until 4PM, DC time.

Compromise or computers: ObamaCare delay inevitable

 “But in some situations, you may see a redefinition of what ‘start’ means.” (Wall Street Journal quoting Obamacare consultant.)

President Obama and Democrats everywhere should be grateful to the Republicans for saving them from a huge embarrassment. Instead, the Dems continue to dig in, escalating their claims to have won a mandate on ObamaCare in 2012, in spite of the fact that the Republicans won enough seats in the House of Representatives to secure a strong majority.

House Republicans passed a new Continuing Resolution that compromises on Obamacare, by changing from refusing funding altogether to setting up a one year delay. Included in the Bill is a measure that would ensure that our military is paid in the event of a shutdown. The Bill also repeals the 2.3% tax on medical devices and the mandate that business owners with religious objections buy insurance that includes controversial “free” contraception.

The Wall Street Journal, in addition to reporting the redefinition of “start,” outlines the many ways that the Federal and State exchanges are not ready to launch Obamacare on October 1:

In the District [of Columbia], people who use the online marketplace will not immediately learn if they are eligible for Medicaid or for subsidies.

In Oregon, people will not initially be able to enroll in an insurance plan on the Web site.

In Vermont, the marketplace will not be ready to accept online premium payments until November.

In California, it could take a month for an insurer to receive the application of someone who applies for coverage on the exchange on Oct. 1.

. . . But as the launch nears, more delays are occurring. On Thursday, the administration announced a delay in the online shopping system for small businesses and confirmed that the Spanish-language site for signing up for coverage will be delayed until mid-October. Earlier in the week, officials said Medicaid applications will not be electronically transferred from the federally run exchange to states until November.

Criticizing Cruz

Update, January 25, 2016 Read about the endorsement from Governor Perry

“I wanted to talk about him, who he was, see if I could get a handle on Ted Cruz the man, not Cruz the caricature I’d seen through the political lens. What I found was a very different person than what I had been led to believe.”

I love what Senator Ted Cruz is doing to fight ObamaCare and the Democrats, and totally agree with his stated goal, but strongly dislike one aspect of how he’s doing it.

Unfortunately, Senator Cruz – who was absolutely correct and exactly on target 99% of the time in his 20+ hour stand in the Senate on Tuesday and Wednesday – leads his crowd in attacking fellow conservative Republicans who support the House Bill that would fully fund the Federal government except for ObamaCare.   This, in spite of the fact that Cruz has said that the fight against ObamaCare is “multistaged,” praised the Bill and House Republicans for their action and even joined in Wednesday’s unanimous Senate vote to consider the Bill in the Senate.

Most people either love or hate Ted Cruz, his agenda and his Senate tactics. There doesn’t seem to be any room for distinction between the Senator, his politics, and his actions.   John McCain called him a “wacko bird.” Harry Reid called Cruz an “anarchist” – along with everyone in the Tea Party. Even Dorothy Rabinowitz, of the Wall Street Journal editorial board, went overboard contrasting Cruz and Senator Mike Lee with the “sane” wing of the Republican party. Bloggers and editors, as well as politicians focus more on Cruz’ “self regard,” his certainty that he’s right and everyone else is wrong and his lack of humility, than on the fight to stem the tide of Federal overspending and government interference in our lives. (See Wednesday’s Senate floor rants of Harry Reid And Dick Durbin, with the classic propaganda technique – or possibly, classic psychological projection – of accusing your opponent of doing the worst thing that you’re doing.)

At the same time, Cruz’ supporters have gone out of their way to call any of the Republicans who didn’t “#StandWithTed,” “traitors” and “RINO’s.” They make no distinction between McCain (who is a “RINO” in my opinion), and Texas’ Senior Senator, John Cornyn, promising to “primary” the latter in 2014.

I urge Senator Cruz and all conservatives to work to build up, not tear down. Do not join the Dems in emotional attacks and accusations. Most of all, don’t turn this into a 3-sided fight between the Dems, the Republicans, and the other Republicans.

Edited to add link to article on John Cornyn. BBN

Federal budget: No real Republican divide

If you only read the headlines and first paragraphs of – or the inflamed comments on – the media coverage of the debate over the Federal budget, you might believe that Republican leaders in the Senate are caving to the Democrats on funding Obamacare. In fact, Senators Mitch McConnell and John Cornyn and Senate Republicans recognize and support the House Continuing Resolution which fully funds the Federal government while defunding Obamacare.

There aren’t just two sides to the story. In fact, the media reports obscure that there are three factions: Harry Reid’s Dems, Republicans who support for the House continuing resolution, and In fact, there are three factions: Harry Reid’s Dems, the Republicans who are garnering support for the House continuing resolution, and the Republican efforts led by Senator Ted Cruz to block even the House Bill by filibuster. Hopefully, Senator Cruz will acknowledge that the House CR makes his filibuster unnecessary.

The House Continuing Resolution is a good Bill, allowing the continuation of the Federal government into December. It’s true that the whole budget debate will continue — but wouldn’t it any way?

“Choosing Wisely: Five Things Physicians and Patients Should Question”

Bookmark this page: “Choosing Wisely: Lists.”

Whether you are seeing your doctor for a cold, a routine physical or a “new patient visit,” or when you suspect that he’s offering you the famous notorious “blue pill or red pill,” how do you as a layman know whether a medical test or procedure is needed? Will it lead to a treatment decision or just more tests? Does it help? Or does it actually cause harm?

Or politically, will ObamaCare cost cuts and rationing deny you a procedure, test, or treatment that would be helpful?

The American Board of Internal Medicine Foundation asked the various physician sub-specialty organizations in the US to list tests, treatments and procedures that don’t help or might actually hurt patients. The lists are published on the “Choosing Wisely” website.

Remember, there’s a difference between screening tests that look for something you might have, and diagnostic tests to explain a symptom from your history or chief complaint, a finding on an exam or to determine whether a treatment is working or harming. And there’s certainly a difference between starting a treatment, doing a procedure or ordering a test that leads to more risk than the disease or condition we’re treating just because . . . of money, out-of-date knowledge, or patient desire. Or because we can.

Whatever health care problem or concern you have, take a look at the list from the medical specialty for the pertinent body part or organ system. Which tests and procedure do you need, and which have you had that are on these lists?

I don’t quite agree with all the items on all the lists. After all, patient care is not a recipe from a given cookbook – and besides, patients’ bodies can’t read the books to follow the recipes.

Let’s talk! Ask me questions and/or let me translate the jargon.

Dr. Jeffrey Singer: The Man Who Was Treated for $17,000 Less – WSJ.com

Health Care DollarsNothing in the world is free, but we’re being told that a lot of expensive health care will be, thanks to ObamaCare. Why would anyone think that this time, government interference will result in anything different?

 

The savings talked about in this article aren’t an option for anyone eligible for Medicare, because few doctors and virtually no surgical facilities are willing to take their cash since any “provider” who enters into these cash-pay contracts must “opt out” of Medicare for two years.

 

Jeffrey Singer writes about the benefits of self-pay medicine and the hazards of involving a third party in the Wall Street Journal:

 

This process taught us a few things. First, most people these days don’t have health “insurance.” They have prepaid health plans. They pay premiums to take advantage of a pre-negotiated fee schedule arranged for and administered by a third party. My patient, on the other hand, had insurance.

Second, even with the markdown for upfront “cash-pay” patients, none of the providers was losing money on my patient. Otherwise they wouldn’t have agreed to the prices. With the third-party payer taken out of the picture, we got a better idea of the market prices for the services. It is the third-party payment system that interferes with true price competition, so “market clearing prices” can’t develop.

Take the examples of Lasik eye surgery or cosmetic surgery. These services are not covered by insurance. Providers compete on the basis of quality, outcomes and price. And prices have continually dropped as quality and services have improved—unlike the rest of health care.

When my patient returned for his post-op visit we discussed the experience. It was clear to both of us that the only way to make health care more affordable is to diminish the role of third-party payers. Let consumers and providers interact through market forces to drive down prices and drive up quality, like we do when we buy groceries, clothing, cars, computers, etc. Drop the focus on prepaid health plans and return to the days of real health insurance—that covers major, unforeseen events, leaving the everyday expenses to the consumer—just like auto and homeowners’ insurance.

A little history: Before I went to Medical school, my husband and I felt lucky to have major medical insurance, to cover hospital bills and some procedures. We paid cash for office visits – less than we pay for co-pays now. My first childbirth wasn’t covered by insurance, but we paid less than $1000, including the hospital and the $300 to the doc. Twenty years ago, I received $1100 (Medicaid) to $1800 (Insurance) for pregnancy and delivery Obstetrical care and the hospital charged about the same. Today, the total is $20,000 or more. (In Texas, 55% of those babies are paid for by you, the taxpayer, through Medicaid.)

While some people think our National problems began back when employers first started offering insurance, at least that was insurance and medical costs remained fairly stable until the late 1960’s. The real problems began when Medicare allowed Congress to collect taxes with a promise of a (hospital, Part A) safety net for those over 65, but spent all the money by “loaning” it to the general budget. From the beginning, Medicare inflated costs by encouraging doctors to raise their fees 10% a year. Private health care costs followed or leaped ahead.

Less than 10 years later, the Democrat Congress invented HMO’s in a failed attempt to control costs – but they still didn’t stop spending Medicare and Social Security dollars. A few years later, there was the very mistaken attempt to limit training to cut the numbers of doctors. The Hill-Burton Act, Stark laws, HIPPA, and on and on, further increased the actual costs, the hassle factors, and government ownership of medical care, while promising more by adding outpatient and drug coverage. Bill Clinton’s Attorney General Janet Reno not only armed Donna Shalala’s Health and Human Services Inspectors, she threatened to prosecute Medicare-eligible patients for contracting private pay agreements with their doctors. She and Shalala held “fraud rallies” in football stadiums with the Director of the FBI, to teach Medicare patients how to turn in their doctors for fraud.

If there is to be a government “solution” (short of getting out of the way), future laws should support innovations like “Direct Primary Care” combined with patient-owned major medical *insurance,* rather than pre-paid health care. For those who truly need help, give tax credits similar to the child credit or even the earned income credit.

Just take care of the patient

Focus on Health, Healthcare will follow 2What causes a frail elderly person to become a patient in the hospital and can we do something in the home to prevent that event?  What causes some people to develop chronic illnesses and can other people intervene to prevent the consequences of those illnesses?

What if healthcare reformers asked these questions rather than focusing (or appearing to focus) only on costs? Better yet, what if they recognized the system changes that work, rather than insisting that all doctors must become employees of mammoth organizations, touting the business opportunities inherent in expensive, user-unfriendly electronic medical records and/or forcing an even more expensive change from the 5-digit medical diagnosis codes in ICD-9 to the 7-digit ICD-10 codes?

The source for the graph above is a report by the Oliver Wyman Healthcare Innovation Center, reviewed in Forbes Magazine last January by author Dave Chase. Yes, 5% of patients are responsible for 45% of the costs. What works to lower costs? Taking care of the patient:

In 2008, when physicians from CareMore, an independent medical group based in Cerritos, California, heard news reports of a brutal heat wave, they began contacting their elderly emphysema patients. Physicians worried that the scorching heat would drive their at-risk Medicare Advantage patients to the emergency room. So when patients said they had no air conditioner, the physicians purchased units for them. The theory was that the roughly $500 cost paled in comparison to the cost of an emergency-department admission. As it happened, this non-medical “intervention” kept CareMore’s patients out of the hospital. But if they had needed to go and lacked transportation, CareMore would have offered a free ride.
CareMore has an expansive, counter intuitive approach to healthcare. The group fends off falls by providing patients with regular toenail clipping and by removing shag rugs—a common household risk for the elderly. Patients engage in iPhone conference calls with healthcare professionals and are remotely monitored with devices that feed data automatically to doctors;  for example, patients with congestive heart failure are given a wireless scale that reports their weight on a daily basis—a key step in preventing hospitalization. They have singing pillboxes that chime when it’s time to take medications.

These unusual tactics produce enviable outcomes: CareMore’s  hospitalization rate is 24 percent below average, hospital stays are  38 percent shorter than average, and the amputation rate among diabetics is 60 percent below average. Overall member costs are roughly 18 percent below the Medicare average.

The electronic medical record helped CareMore identify patients at risk, but the EMR is a minor tool compared to the minds of the innovators who recognized the real problems and acted in the best interest of the patients.

Obamacare Consumer Cost Protections–Delayed! | National Review Online

Or, as my granddaughter said, “Was he BORN dumb?” We, the people, will now pay more than we were promised!

The Obamacare “train wreck” continues. Now, the NYT reports, the caps on out-of-pocket expenses–you know the “affordable” part of the Affordable Care Act–are being delayed a year

via Obamacare Consumer Cost Protections–Delayed! | National Review Online.

Why not “delay” the whole thing?

Obamacare months behind in testing IT data security: government

Just in case you thought we were exaggerating:

The missed deadlines have pushed the government’s decision on whether information technology security is up to snuff to exactly one day before that crucial date, the Department of Health and Human Services’ inspector general said in a report.

As a result, experts say, the exchanges might open with security flaws or, possibly but less likely, be delayed.

****

 

IDENTITY THEFT?

When people try to enroll in health insurance starting on October 1 for insurance plans taking effect in 2014, their identity, income and other information they furnish with their application will be funneled through a federal “data hub.”

The hub is like a traffic circle for data. It does not itself store information, but instead has digital spokes connecting to the Internal Revenue Service and other agencies that will allow it to verify information people provide. Opponents of Obamacare have repeatedly raised concerns that sensitive personal information could be stolen.

 

Read more of the story via Obamacare months behind in testing IT data security: government | Reuters.

Hat Tip to Congressman Michael Burgess and today’s “TMA Member Physician’s Daily”

Podcast: Stop ObamaCare – Greg Abbott

From the Greg Abbott Campaign website:

Communications Director Matt Hirsch speaks with Dr. Beverly Nuckols on location at The Texas Mailhouse in Austin about the negative impact ObamaCare is having on small businesses and the health care industry, while U.S. Secretary of Health and Human Services tries to sell an unworkable, expensive healthcare takeover in Texas.

via Podcast: Stop ObamaCare – Greg Abbott.

(I’m a doctor, not an audio/visual expert. And I certainly can’t afford one. Since I can’t get the podcast to embed, so please go to the site. While you’re there, volunteer, donate, help out!)

ObamaCare’s effects difficult to measure: USA Today

From the USAToday, August 8, 2013:

When California announced that individual premiums in its health insurance exchange could be 29% lower than expected, President Obama cheered. When Indiana announced premiums might be 72% higher than before, state officials predicted doom. So who is right? Are health insurance premiums going up or down?

We don’t know, at least in part, because both sides are playing with the numbers. To be sure, natural variation exists in how state insurance markets will be affected, but consumers should also be aware of how premium comparisons are twisted to reach predetermined results. Here are five ways they have been slanted: . . .

read more via ObamaCare’s effects difficult to measure: Column.

Edited 8-9-13 – Changed the title and post to make it more clear that this is from the USAToday, not my own writing. BBN

Texas or DC: Who do you want regulating your doctor?

Peggy Fikac once again proves that she’s not a reporter, and most certainly not anything like a fair and balanced media representative.

From the Houston Chronicle’s coverage of events in Austin, today:

“Obamacare is the wrong prescription for American health care, and I will never stop fighting against it,” Abbott said, joined by small business people and a doctor who also oppose the law at a company, the Texas Mailhouse.

One reason that Abbott gave for fighting the law came in response to a doctor who asked him from the audience about what Texas could do to keep the federal law from interfering with doctors’ judgment about the best way to treat their patients.

“You’re raising one of the more challenging components of Obamacare, and a hidden component in a way, and that is government is stepping in between the doctor-patient relationship and trying to tell you what you can and cannot do, interfering with both your conscience and your medical oath to take care of your patient,” said Abbott, who is campaigning to succeed Gov. Rick Perry.

That is similar to arguments raised against tighter abortion restrictions approved in special session, including a ban on the procedure at 20 weeks, along with stricter regulations on clinics and abortion-inducing drugs.

 

I am that doctor from the audience. Ms. Fikac is correct that I voiced concern over the Federal interference between the patient and the doctor. She’s flat wrong about Texas regulation of medicine by bring abortionists up to standards being equivalent to the

I prefaced the question by noting that it is the State of Texas that properly regulates Texas Doctors and medicine. At the State level, patients and doctors have more influence on our elected officials and the people they appoint to write regulations and enforce the law than we do on the Federal level.

I also noted that because of the increasing interference over the years by Medicare, I am concerned about the reach that this new set of regulations will have, including ever-invasive micro-reporting of patient’s private medical conditions. (I named the upcoming move to the ICD-10, which will be a nightmare, requiring doctors to make distinctions between medical conditions, out to five (5) decimal places.

As bad as the bureaucracy of the Office of the Inspector General for the Federal Health and Human Services and the Centers for Medicare and Medicaid Services have been in the past, I don’t look forward to the additional layer of IRS income verification, audits and enforcement.

We could stick closer to home, with the Texas Health and Human Services, the Texas Medical Board, and the Texas Insurance Commission!

Freedom2Care: Now Secretary of Health and Human Services Kathleen Sebelius is not radical enough to work at Rite Aid

Conscience? More “Trust me, I’ll violate my conscience” news:

Tolerance. Diversity. Broad-mindedness. Those are the words.

Bullying. Discriminating. Compelling. Those are the deeds.

The contradictory words and deeds often come from one and the same individuals–and in a case I learned about today, companies. Turns out the words of tolerance, diversity and broad-mindedness only apply to those who comply with the dogma and submit to the will of the speakers.

Here’s an email I received this morning from a pharmacist member of the Christian Medical Association:

“Subject: Forced to resign over mandate to sell the morning after pill.

“Just to let you know that Rite-Aid corporation came out with a stricter policy on July 5, 2013 that requires all employees to accommodate the sale of the morning-after pill to all comers, of either gender and of any age.”

Read more via Freedom2Care: Now Secretary of Health and Human Services Kathleen Sebelius is not radical enough to work at Rite Aid.

While I don’t believe that Plan B is an abortifacient, I do believe it’s a powerful drug and that adolescents shouldn’t be able to buy it over the counter. I also find it hard to trust someone who will agree to go against their conscience!

Dr. Wes: A Case of (Medicare) “Fraud”

A real-life, real medicine tale of the risk that doctors face – and are willing to face – when taking care of our patients under arbitrary and often outdated Medicare regulations. It will only get worse under ObamaCare and the IRS.

He was a slender-framed man, mid- to late-sixties, with a kind of ridden-hard-put-away-wet complexion.  It was clear the years had not always been good to him, but being the kind soul that he was, he had plenty of friends.  It was a beautiful summer day to spend with friends for a barbecue, but he arrived feeling puzzled why he collapsed at home earlier in the day.

He stopped at the keg and poured himself a beer in a red solo cup, and as he approached his friends with a smile, he did it again, this time which such gusto that his beer went flying and the thud he made when he hit the ground made everyone gasp.  He laid motionless for a moment face down on the ground while his friends rushed to his aid.  An ambulance was summoned as others rolled him over onto his back.  He began to move – slowly at first – then more purposefully.  As sirens approached, he asked his friends, “What just happened?’

Read the rest of the story here.

The author’s comments:

It is becoming abundantly clear that conflicts between the [sanctity] of human life will confront the government’s unwillingness to pay for procedures. No where is this more clear than with approval of payment for the implantation of an ICD, which might run in excess of $200K for the procedure at some instituions. As a result, doctors who strive to provide state-of-the-art care to their patients will continue to confront similar ethical dilemmas that risk their legal standing (and credentials) as they care for their sickest arrhythmia patients.

By publishing this case scenario, my hope was to draw attention to these ethical dilemmas that are becoming increasingly prevalent in medicine as a result of these outdated, inconsistent, and incomplete coverage decisions, guidelines for care, and “appropriateness use” criteria. Further, the potential for legal action against physicians y imposes real fear for do

ctors if they stray at all from these outdated decisions. This fear is to the point where it might do actual harm – and even cause death – to patients who are left without appropriate treatment as a result.

via Dr. Wes: A Case of Fraud.

Every Slice of Drug-Rep Pizza Counts Starting Aug. 1

It’s possible that I can be bought, and no one’s come up with the right amount of money (or pens or pizzas), yet.

Or maybe, just maybe, I’m honest. Of course not!

I’m assumed to be guilty (where’s the opportunity to prove innocence, much less their duty to prove me guilty?) of all sorts of fraud by authors of the Physician Payments Sunshine Act included in the thousands of pages of PPACA – otherwise known as Obamacare:

From now on, companies must keep track of virtually every payment and gift bestowed on each clinician and report them to the Centers for Medicare & Medicaid Services (CMS), which will report them to the world.

This accounting exercise stems from a provision in the Affordable Care Act (ACA) that seeks to expose the financial dealings between industry and physicians and discourage conflicts of interest for the latter that might skew education, research, and clinical decision-making. Under the ACA provision, called the Physician Payments Sunshine Act, drug and device makers must report any “transfer of value” of $10 or more made to a physician. Transfers of value under $10 — a cup of coffee, say — aren’t reportable unless they add up to more than $100 in a year. Companies also must disclose whether physicians have any ownership stake in them.

via Every Slice of Drug-Rep Pizza Counts Starting Aug. 1.

Of course lawmakers assume that we’re being bribed – that’s what they do! Why aren’t the limits at least as high as those our Senators and Representatives are allowed? Like Democrat Senator Harry Reid, can we form a “Friends of Dr. Practice” and get more, as long as we don’t accept donations at our office?

BTW,  there’s an app available to help doctors keep up with the bribes.

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