Health News and Scoops

Obama stated not long ago that medicine has become more of a “business than a calling.” I could not disagree more with that statement. Medicine has remained a calling for many, but with the salary cuts and lack of regulation of insurance companies, physicians and surgeons have been forced to run a business. Obama has misinterpreted the situation. If you have read my previous posts, you understand that attending medical school at this time is close to a half a million dollar investment, followed by three to six years of a salary under $45,000, followed by one to five years of a salary under $60,000. If physicians have to spend $4,000 per month paying back loans for 10 to 25 years, and insurance companies will only pay 50% of what their procedures actually cost, one can imagine that pretty soon, the physician’s private practice has to operate as a business.

This is a small digression.  My purpose in mentioning Obama’s statement is that in order to make up for the extreme debt and very low net salary of private practice physicians, private practices have participated in incentives given by pharmaceutical companies.  These companies provide gifts, money, and various other incentives to physicians in order to ensure that their product is used. Often the drug companies will give significant monetary benefits for physicians to push the use of their product, and to push the drug over other, cheaper drugs that are essentially the same.

A law passed this summer in Vermont has set out to ban that practice. It is certainly for the benefit of the patients and their wallets to do so (and the physicians can only hope that reform comes soon so that they can stop taking all the hits when it comes to health care reform). The law, which was signed on June 8^th, “bans gifts to physicians from manufacturers of prescription drugs, medical devices, and biologic products, with few exceptions.” These exceptions “include the provision of drug samples for free distribution to patients, the short-term loan of medical devices to permit their evaluation, and the distribution of journal articles and other items ‘that serve a genuine educational function.’”

What all of this really means is that Vermont has taken the first real step forward in an effort to reform the health care system. Perhaps Obama can learn from this, in that we do not necessarily have to change the entire health care system in one giant leap; we can chip away at it by ridding of the small but numerous abuses of the system.

4jcxr2diyn

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Health care reform is currently a hot topic, but, like it has been for years, it is one that tends to make great progress in words and little progress in action. The current health care system in the United States is a futile cycle that only ends up generating heat rather than energy. The problems are clear; the solutions are not. We need to lower costs. We need to ensure that everyone is insured. We need doctors to perform fewer expensive, unnecessary tests to lower costs. Doctors need to perform more unnecessary tests to avoid litigation. Ah ha! One of the major dams in the flow of health care reform is litigation. Medical tort reform has attempted to surface itself in congressional debates on a yearly cycle, yet with the storm of medical lawsuits in the media “calming down,” its presence has all but disappeared, to the public.

This week in the New England Journal of Medicine, a panel of medical law experts argue that medical liability reform packaged with federal health care reform is the best way to go about making a change. Why? Because defensive medicine is driving the cost of health care to the roof, and change in litigation could provide some possibility for how to fund the potential health care reforms. In addition, health care reform is going to need the support of physicians, particularly when they are being asked to forgo more of their income for the sake of broadening access to health care (keep in mind the half of a million dollars in debt that many new M.D.’s find themselves in at this time).

Litigation reform would most likely gain the support of physicians, as well as many key Republicans, piecing together Obama’s desire for health care reform in a bipartisan fashion. Two major reform possibilities are outlined in the article mentioned, the first being the Patients’ Choice Act, and the second being the Fair and Reliable Medical Justice Act, proposed by Republicans in both the House and Senate. The Patients’ Choice Act calls for a behind-the-scenes litigation policy, where physicians and surgeons would verbally disclose their mistake to the patients and subsequently offer a payment deal. The patients wouldn’t have to accept, but it has been shown that nearly all patients accept pre-trial deals. This approach seems a little bit too sketchy, and gives off a hiding in the shadows feel, but perhaps the non-public aspect to it would be more favorable to physicians and may avoid the injury to their career that lawsuits often cause.

The second approach, and the most reasonable in my opinion, is the Fair and Reliable Medical Justice Act, where a committee consisting of uninvolved, neutral medical experts would decide whether the physician acted properly in the case at hand.   This approach seems the most practical because juries, without expertise, tend towards the emotional aspect of the trial. Bringing a child without her arm into the courtroom almost always leans the jury towards the patient, even if the medicine was perfect.

Another positive aspect of this approach is the ability to judge physicians on Comparative-Effectiveness Research (CER). This would provide physicians and surgeons with incentive to make decisions based on CER rather than continue defensive medicine, which would reduce cost and improve CER research simultaneously. Reduce costs and improve care? That might be too logical, but we’ll just have to wait and see.

Tags: access to health care, federal public health, Health, health care reform, litigation, medical community, medical lawsuits, medical litigation, reform, tort

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Olympus Managed Health Care, Inc. (OMHC), a leader in international strategic claims management, including cost containment, announces new services focused on the domestic health care payer. Olympus is extending its expertise perfected over 15 years in the international claims management business to the U.S. healthcare marketplace, providing proprietary claims management tools and data to manage claims and contain costs for fully insured, self-funded, HMO and worksite clients such as Mini-Med’s, HSA’s or other limited benefits plans.

Olympus also provides unique solutions under its Patient Care Advocacy Program that is designed to assist the client with facilitating access to health care and s-t-r-e-t-c-h-i-n-g their limited health care dollar; a great match for enhancing worksite product offerings. The Olympus proprietary international network provides “medical tourism” packages resulting in access to high quality health care at dramatically reduced costs.

Olympus combines cutting edge technology, a team of highly trained claims analysts along with a medical staff that specialize in managing medical care and detecting overcharges, erroneous or fraudulent claims, and cases that are most susceptible to over-billing.

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