Wednesday, December 19, 2007

Band Aids are NOT good healthcare for Seniors

While most of the country was completely unaware, a very important piece of legislation was passed by the U.S. Senate yesterday. However, it is only a short-term band-aid to a major gash in the U.S. health care system... a wound affecting over 44 million Americans plus 1500 new Americans every day. What is it? Read on my friend!

Medicare reimbursement for physicians. Now, I know that may sound selfish coming from a future physician, but let me explain the facts. Physicians in this country were due for a 10.1% reimbursement cut on January 1st, which has now been pushed back 6 months to give legislators more time to resolve an issue that they have stalled on, and band-aided every year for the past 6 years. While medicare reimbursement rates to other types of health care providers have gone up over the past few years, the rate for physicians and private insurers who provide medicare type benefits to seniors have stayed flat. The only reason they have stayed flat and not decreased is the repetitive band-aid approach. The problem is that the cost of operating a medical clinic is going sky high, so if reimbursement rates do not follow it becomes very difficult for a physician to give time to medicare patients or to accept new medicare patients (think Baby Boomers hitting retirement...). As a future physician, and the son of parents getting closer to medicare age, I am deeply concerned about the impacts of medicare reimbursement on quality of care for our seniors!

Many physicians are practicing in areas where their patient base is 30, 40, or even greater than 50% medicare! So many physicians are facing the ethical dilemma of not seeing Medicare patients, or having to charge them an extra fee to make up the difference, or reducing their visit time with medicare patients to see more patients total. None of these options are good options, especially if you know somebody who is on medicare, will be on medicare in the near future, or if you are on medicare yourself.

The 10.1% pay cut that was due on January 1st will still take place at the end of June if Congress doesn't finally act to fix this thing. In fact, the next 8 years are scheduled for 5% cuts each year under the current algorithm that bases physician reimbursement on whether or not spending growth is more or less than an economics-derived target rate. If spending growth in health care exceeds the target rate, physicians get a pay cut. The problem is that everything in health care is getting more expensive, at a rate faster than economic inflation. So ultimately we are looking at a 40% pay cut from Medicare by 2016. It is pretty much a guarantee that Physicians will not see Medicare patients regularly if that is the case. Best-case scenario is that they have their mid-level providers like Physician Assistants and Nurse Practitioners see them, but -40% will still make that virtually impossible from a business standpoint.

Medicine should not be a business and physicians should not have to worry about what patients they can and can't see in order to stay in business. The medicare system as it stands is going to force Physicians to put business ethics above medical ethics and that is wrong. We need our congressional and senatorial leaders to make this change for the future of our seniors and our health care system. We need our next president to care about health care for seniors, reducing health care costs (reduce costs for physicians and reimbursement cuts are not a problem), and improving the quality of health care in America!

Friday, December 14, 2007

Crawling to the finish line

Well, I've met my match. Throughout my collegiate career I always managed to hold off until Christmas break to get sick. But not this year! Not only am I breaking my trend, I'm now on my second cold in the last month. Of course my mind has decided to try and formulate some reasons for this new found immunological breakdown...

1. I'm 28, not 25, or 21. Apparently I'm not invincible... who knew?
2. The 4 month long finals week.
3. 5 exams over a 10 day period just wasn't enough challenge... "Go big or go home!"
4. Woot. (certain people will understand)
5. Several months of sniffing formaldehyde in the anatomy lab has convinced my body that it is, in fact, dead.
6. Speaking of anatomy lab... a thorough dissection of the male genitalia has been shown to have all sorts of side effects in male medical students (i.e. mild-to-moderate depression, lower abdominal/inguinal pain, deep feelings of disloyalty to one's team).
7. Bacteria and Viruses thrive in moister environments... There's more humidity in Des Moines than Colorado... THEREFORE... humidity kills! There, I said it.

I need a cough drop... and a hug.

Thursday, December 6, 2007

Disco Doctor?

Check out this article:

"Associated Press -
updated 1:42 p.m. CT, Fri., Nov. 2, 2007
SYRACUSE, N.Y. - A dentist was dancing to a song on the radio while drilling on a woman's tooth, and she wound up in the hospital when the drill bit snapped off and lodged near her eye, a lawsuit alleges." And what song was he dancing to...
1976 hit song 'CARWASH'!!! What the heck??? We all know that the only appropriate disco song for the doctor's office is 'Stayin Alive' by the BeeGee's! I hear that they're going to make a movie about this Dentist, and John Travolta will be playing the lead...

The Myth of Medical School

Have you ever wondered what medical school really is like? I did before I got here. There is this social myth or mystique or urban legend or drunken monologue in our world about the secret society of medical school. While it is hard and challenging, it definitely is not what you think it is... so let me reveal to the world the truth... and it all starts with free lunches!

"Free lunches???" is what you are saying. Yes, free lunches are near and dear to the medical student amongst many other things. You see with our class load and debt load combining with the requirement of extracurricular activities (to get into a good residency), clubs and other organizations wishing to get a portion of our time are limited to the lunch hour. Essentially, Free lunch = attendance. Of course by "free" I mean that my club dues OR my tuition pay for it, but "FREE" sounds so much nicer. That is a nice segway to the fact that aside from our classes and studies we do have to be involved in clubs and community service/outreach both to satisfy the humanitarian values that most of us have and to help us get into that all important but completely and subjectively undefined "good residency" after medical school. In my case I am a member of 4 clubs and am an active 1st year leader for one of them; the Student Osteopathic Medical Association or SOMA.

Another vital aspect of medical school is your ability to acquire the prime study spaces. Many students think this is an acquired or teachable skill, but I happen to think it is a gift bestowed by God upon a select few individuals. Seeing the sad, longing faces of other students wander past the closed door of the room that you just snagged, knowing that they will make 2 or 3 more passes by your door just to be sure it is occupied is both shaming for a few seconds yet mostly exhilirating. Away with you to the glorified cherrywood voting booths we call 'study carrels'!

So let me get to the point. Medical school is hard academically and somebody must have some intellectual and intestinal fortitude to get through. But really it isn't just classes and studying. It is a lifestyle that is unique and there is camraderie that is so enjoyable! You do have to find joy in the little things like free lunches and stumbling upon the one open study room, but is that really different than a co-worker proactively smiling and saying hello, or getting a compliment from your boss, or realizing they're serving your favorite lunch in the cafeteria?