Enjoy our most current issue of the most popular medical e-newsletter on the internet.
Blogs and Thoughts for May 17th to May 23rd, 2018
Here is what we had this past week:
- Tech Savvy Fluff from Medical Schools and the AMA
- How Drug Companies Block Generics
- Narco by Stephen Vaughn MD, Ph.D
- A Little Hysteria Never Hurts Anyone by Pat Conrad MD
- More Universal Magic by Pat Conrad MD
- Friday Funny: ED
- Quote of the Week: Audre Lorde
1. Tech Savvy Fluff from Medical Schools and the AMA
May 23, 2018
Here’s a fluff piece for you:
The first graduating classes from some of the 32 medical schools to participate in the American Medical Association’s pioneering curriculum modernization initiative are now ready to take their tech savvy to hospitals and practices nationwide.
Really? I wonder if people of real significance in history ever said they were “pioneering” anything? Anyway, let’s see what makes them so special:
ACME was launched back in 2013 with the goal of helping “close gaps in readiness for practice,” said Susan Skochelak, MD, group vice president of medical education at AMA, aiming to educate students in the information technology, techniques and value-based philosophies that have come to define healthcare in the 21st Century.
At the time, a recent poll had shown that only 64 percent of medical school programs even allowed students to get hands-on experience with electronic health records.
“When you talk to people who are hiring in the major health systems or you talk to graduates, what they’ll say is they really are not prepared. They don’t know how to manage panels of patients; they don’t fully even necessarily know what to do with an EHR,” Skochelak told Healthcare IT News at the time.
This is called out-of-touch with reality. Manage panel of patients? How about learning to treat patients individually? And who doesn’t know what to do with an EHR? In fact, each place you go has a different EHR. You have to learn the idiosyncrasies of each one. It really isn’t that hard to learn but they are almost all built to satisfy the insurance companies and hospitals but not the patients.
The curricula costs $12.5 million in grants from AMA and they are putting 19,000 medical students through it. Wow. How about using that money to create MORE residencies so some of these medical students can become doctors instead of ending up being a scribe? Oh, wait, now I get it. This is perfect training for some of them.
2. How Drug Companies Block Generics
May 22, 2018
Did you ever wonder why generic drugs never seem to come out or are still expensive? Well, I discussed some collusion and price fixing before here. Now the FDA is “making public a list of 52 brand-name medicines that generic-drug companies have had trouble getting samples of, due to restrictions from the manufacturers. Generic companies need large quantities of the brand-name drugs to test them for bioequivalence so they can get their own versions on the U.S. market.”
They do this by improperly “using the safety measures as a pretext for blocking generic companies’ path to entry.” Basically, they stop the process right in its tracks and this has been allowed for years. This administration wants this stopped and I agree.
It is a weird thing to help your competitor undercut your price. It is also weird for the government to shame them into complying. I still don’t care. I think all bets are off when dealing with any member of the Medical Axis of Evil. My favorite part of the article, though, was this:
Members of the Senate and House on both sides of the aisle support a bill, known as the Creates Act, that would give generic companies a legal cause of action in such circumstances. In the Senate, there are 22 co-sponsors, 11 each from both political parties.
Sen. Patrick Leahy (D., Vt.), the bill’s chief sponsor, said, “The best way to lower the price of prescription drugs is to meaningfully increase competition. Our bill would do that.”
Uh, what? Meaningfully increase competition? Yes! Finally, some sense from the left on this. No subsidy. No free lunch. Competition.
Or did I miss something here?
3. Narco by Stephen Vaughn MD, Ph.D
May 21, 2018
I came across a story today, shocking and all too common. Some individual in Texas has apparently been running a medical billing racket. If it’s true, he hurt lots of people.
A task force investigating his guy announced Monday that “he was being indicted in a fraud case involving $240 million in claims that were in part based on “fraudulent statements” to be submitted to health care benefit programs, resulting in $50 million paid to the doctor.” (CNN)
This stuff is large-scale organized crime, not medicine. “The indictment also accuses this doctor of being a part of an extensive international money-laundering scheme, saying he laundered money through a money exchange house, known as a casa de cambio, and sent it to various accounts in financial institutions in Mexico.”
Follow the money. It boggles my mind that a physician could bill out services that result in $50 million paid by an insurance company, Medicare or Medicaid. “The Department of Justice said Monday that the rheumatologist had given patients chemotherapy and toxic treatments they didn’t need, all to fund his “lavish” and “opulent lifestyle.””
“The Department of Justice is seeking the forfeiture of his million-dollar personal jet, a Maserati that had ZQ — his initials — painted on its exterior and several of his luxurious properties.
This guy owned a fleet of luxury cars and purchased numerous expensive commercial and residential properties, including two penthouses in Puerto Vallarta, Mexico; a condo in Aspen, Colorado; and one in Punta Mita, Mexico. He also owned multiple homes and commercial buildings in Texas, court records show.”
This is big-league evil, the equivalent of a narcotics trafficking cartel.
What bothers me about the spin at the end of the article is hearing a Federal agency weigh in on the matter. “This case is certainly not an isolated incident involving potential medical fraud. Health care fraud costs the country about $68 billion annually, according to estimates from the National Health Care Anti-Fraud Association, and that’s probably a conservative number. That’s about 3% of the $2.26 trillion the country spends on health care, according to the association.”
First – the National Health Care Anti-Fraud Associationisn’t doing its job. They bill themselves as the leaders of the healthcare anti-fraud industry. This phrase bothers me. If we’re talking about this scope of money, it’s theft at the size of organized crime, gangs and cartels. It’s not the small fry. There just isn’t enough billing done by hospitals and other institutions to rival the $400 million a year that this guy is accused of.
Somehow, the healthcare payment system that we have today in America is rickety enough that an entire industry has to be constructed to minimize its being defrauded. Where’s the FBI and local law enforcement?
Secondly, when you move a large volume of money around any industry, it attracts crooks. We have a massive, centralized payment system that the crooks have learned how to loot like hijacking the stagecoach. The people being robbed are the patient who are in need of services, as well as the honest healthcare providers who enjoy providing these services.
The best enforcement that the “healthcare industry” could have is not a “healthcare anti-fraud industry.” Direct primary care is the micro-scale granular provision of services, and if the patient is not satisfied, the patient does not pay. End of story.
If we could only stop moving the money around in massive, ten-million-dollar chunks, signed off by bureaucrats who-knows-where, and have actual interpersonal transactions, a lot of the nonsense that went on in this woeful case would never have happened.
Don’t forget, if this guy is convicted and thrown in prison, there are still patients who were cruelly misdiagnosed and mistreated for unspeakable reasons. Even if they received some remedy, I expect more than a few will be crippled for life. They deserve more from our healthcare system than “Whoops! Sorry.”
And blaming doctors for this is the equivalent of blaming Mexican immigrants for MS-13 Most of the people who cross the border, illegally as well as the vast many who have come legally, are no threat. Blaming them for the crimes of the real criminals does no benefit and is a lazy way of pretending to go after the problem. Target the criminals! But that is hard work and scary. The criminals have guns and attitudes. The Mexican nationals are usually shy and frightened and can be pushed around. They are much easier to bully.
And so are the doctors. As much as the “anti-fraud industry” wants to appear like they’re tigers confronting massive racketeering and organized crime, most of them just intimidate the honest working doctor, reminding them that health care fraud is a felony under various states’ Health Care False Claims Act, punishable by up to four years in prison, a $50,000 fine and loss of health insurance. It’s also a federal criminal offense under the Health Insurance Portability and Accountability Act. (from BCBS Michigan website)
We know that. We are not out to make money in healthcare to commit fraud. We are here to take care of people. Why target the average doctor to stand in for the rotten ones?
4. A Little Hysteria Never Hurts Anyone by Pat Conrad MD
May 20, 2018
An Indianapolis woman died last week from necrotizing fasciitis, a truly sad story. Following a vacation to Florida, she noticed a sore on her buttock. Two visits to her primary doctor for antibiotics and heating recommendation, then to the hospital when it worsened. Between news accounts and some pretty sloppy journalism, it’s tough to tell exactly who did the biopsy when the area worsened. The primary, the ER, infectious disease after she was admitted? We can’t say. She was diagnosed, and admitted to the ICU for 16 days following surgery. The patient was then released home where she made lunch (the next day?) for her husband, who found her that afternoon, dead.
The episode is tragic, and the husband is understandably grief-stricken. So it does not help that a huff-huffing media cannot present a cogent timeline in its rush to scare with another ‘Flesh-eating Bacteria!!” headline. And it does not help any of us for the media to include in the lead paragraph, “… but her husband believes she would still be alive today if doctors had diagnosed her earlier.” While technically possible, it implies the doc in the office somehow blew it by not doing a tissue biopsy for a condition that would not have clinically warranted it at the time. And the slobbering reporters just had to include this from her husband: “He told Tampa television station WFLA that he thinks his wife may have contracted the bacteria from a hotel’s hot tub.’My thing is, nobody else got it, the flesh-eating bacteria. She was the only one that got in the hot tub,’ he said.” Or she might have gotten in in any of a thousand other spots in a state where MRSA is practically airborne (believe me, I live here).
What were the patient’s co-morbidities, if any? Was she clinically stable the day of discharge, and was she feeling better? Was it the infection that killed her, or did she develop a pulmonary embolus while in the ICU? The coroner has not yet said, and the hospital is appropriately mum.
A friend of mine observes of such cases that “living is a dangerous business,” and he’s right. I’m not calling for restrictions on freedom of the press, and I’m sorry for the husband. But chumming all the water for shark lawyers with a bunch of half-reporting is not going to bring her back, is not going to prevent the next such death, and will keep the rest of us just that much more anxious to do a biopsy absent any clinical indication.
5. More Universal Magic by Pat Conrad MD
May 19, 2018
Last year Forbes had an article suggesting that the fix for our health care mess is pricing transparency: “‘Single-Payer’ Healthcare Isn’t Necessary — But Single Pricing Is.” The author’s point is that our entire debate premise is wrong, because our entire tiered system leads to price obfuscation, and downright opacity.
Okay, I’ll bite. How do we get that transparency? The author Dan Munro’s answer is simply, “universal coverage.” He states, “The only way to lower the cost is to end coverage,” which makes sense. It’s confusing (to me) because he seems to contradict himself. “Payment and coverage are definitely connected, but that connection can and should be simple and transparent–not complex and opaque. Universal coverage is that simplicity and transparency.”
So how does that happen? Here the author takes a dive: “Obviously, how universal coverage is paid for (either single- or multi-payer–delivered through government or privately owned industries) is a critical debate, but who qualifies for coverage (and under what terms) shouldn’t be.”
Munro says that the three arguments against universal coverage are clinical, fiscal and moral, and that they all fail. He claims a modest but measurable 20% drop in all-cause mortality for the insured. He states that our $10,877 per capita annual expenditure on health care does not invalidate universal coverage because other nations with US have lower per capita costs and better longevity. Munro cites Germany circa 1883, and a Martin Luther King, Jr. quote as his proof of the moral imperative. He doesn’t take issue with Bernie Sanders “Everything-Is-Free” care, and only decries the money: “At almost $11,000 per capita per year, our healthcare system is a gigantic monument to the priorities of ‘shareholder value,’ inequality and injustice–at scale.” Munro calls out the bad guys: “Payers, providers, pharma, suppliers, educators, software vendors and medical device manufacturers are all harvesting enormous profits from our $3.4 trillion ‘medical industrial complex.”
He thinks the only real debate over universal coverage is payment mechanism, and the other problems would all be solved with single pricing and ending annual enrollment. And “because we don’t need single payer to get to single pricing.” If there is truly single pricing, then who sets the price? Which gets me back to Munro’s list of culprits above. He does say “payers”, but I question whether in his mind that includes government, because that is certainly who will set prices. And when they do, the big health corporations will cease offering less profitable services and meds. Oh wait, that’s already happening. And Munro conspicuously omits another group of culprits: patients and family members. Like every other universal coverer, he makes no mention of patient accountability, or patient/family expectations. How would he fund the recalcitrant smoker? How would he protect the hospital that wants to discharge an advanced dementia patient from the ICU with sepsis, with no spare beds and the ER backed up with patients who are all covered?
Experts from all walks keep coming up with “solutions” that never address exactly who or how all of this is paid for, and when and how someone will be told “no.”
6. Friday Funny: ED
May 18, 2018
Well, I thought it was funny. Check out Cyanide and Happiness at www.explosm.net
7. Quote of the Week: Audre Lorde
May 17, 2018
“When I dare to be powerful – to use my strength in the service of my vision, then it becomes less and less important whether I am afraid.”
UNTIL NEXT TIME, KEEP SMILING, KEEP LAUGHING AND KEEP OUT OF REHAB!
Douglas Farrago MDTweet