Published CommPro.biz 2014.03.25

Congress Blocking Doctors

Last Friday (2014.03.21) was “Match Day.” On that day thousands of mostly young doctors opened an envelope that confirmed their acceptance into a residency program. In many cases it defines the path their medical career will take for the rest of their working life. In most cases they knew they were in and just awaited final confirmation. For some it was their first choice and this was the first year they had been down this path. For others, they settled for what they could get. Others were back for another try, having missed the cut in earlier years. Still others missed the cut this year and will have to wait for next year, or perhaps the next, or the next, often while staring at a massive student loan debt.

For a nation facing a massive physician shortage –100,000+/- by the end of this decade– this is insanity. The number of residency openings is controlled by the United States Congress. Why there should be a problem with supporting this vital aspect of our healthcare system escapes us. However, we are living under a nearly two decade old cap put in place by the Congress. Given those in that body who are focused on anything but serving the people of the United States, it’s not likely that we’ll see a change.

On the other hand there’s good news. The number of bright young people –split about evenly between men and women– who applied to medical schools and the number enrolled as first-year students hit record highs this year. Add to that a dramatic increase in young doctors choosing family medicine. Five years ago it was under 60% with more than four in ten opting for specialties. This year it’s over 66% with less than one in three aiming for the specialties. That indicates a growing awareness among young doctors that the team-based comprehensive care ACA encourages is where the future lies. Primary care doctors will head-off serious illness in the future, saving lives, improving the lives of their patients and reducing healthcare costs.

There’s a new day dawning; young people entering medicine see it. Beat illness to the draw, make prevention the goal. The old model, treat people after they get sick is on the way out. Paying doctors based on the number of patients they run through their practice is so over. Payment needs to be focused on outcomes, on the overall health of the patients under a doctor’s care. America spends more per patient than any country on this planet. Yet we rank among third world countries when it comes to outcomes. The ACA is a baby step in the right direction.

Our lawmakers need to do the job they were elected to do, to serve the interest of all the people of the United States. They can begin by opening up more residency slots for young doctors who have fought their way into medicine, and are ready to go to work.

Published 2013.10.31 CommPRO.biz

Do No Harm

The Hippocratic Oath is a widely edited set of guidelines credited to a long-ago Greek medical practitioner. It is estimated that 98% of medical students swear some form of oath, as do a large percentage of dental graduates. These oaths are focused on ethics and are often condensed into, “Do no harm.” Recent reports of predatory lending practices by doctors and dentists give us a picture of the other two percent.

Patients who lack insurance and those who need or want procedures not covered by their insurer, are being herded into various medical credit cards that are little more than tools created to ripoff the unwary by the monster banks and their lackeys. Wells Fargo and Citibank seem directly involved while others hide in the shadows providing the funds for the smaller credit card issuers. It’s the same set of scams and scammers that created the sub-prime mortgage disaster and more recently the on-going payday loan racket. They seem to be betting on the Justice Department giving them another get-out-of-jail-free card no matter how or who they ripoff.

The unwary –Who doesn’t trust their doctor or dentist?– sign up for these cards right in the doctor’s or dentist’s office. They are told that they will pay no interest if the card is paid off in three or four easy payments. What the docs don’t say is that you will be slapped with interest charges –close to 30% in some cases– if you don’t pay up before the end of the interest free period.

Let’s say you owe $1,000, about average for extensive dental work or plastic surgery. And let’s say you haven’t been able to make any payments over the four month interest free period. In most cases you’ll owe interest from the first month on the entire $1,000, plus the compound interest for the additional three months. You’ll be in hock for a lot more when the fourth month comes around. You can see that this is not going to end well when you start adding on late payments etc.

One of the independent card companies specializing in healthcare credit cards is said to have between five and ten million card holders. In addition to the medical practitioners who swear to do no harm, there are medical device hustlers, selling everything from power scooters and chairs, to hearing aides. These people aren’t even restrained by a “Do no harm” oath. Although, when bucks are at stake some doctors and dentists don’t seem able to recall that phrase.

These practices are beyond unethical, beyond immoral. Doctors and dentists who lead people into these scams may not be breaking any laws, but they are certainly –or should be– on shaky ground with state licensing agencies. A few suspensions would slow down this racket A couple revocations for the worst cases might stop it dead in its tracks. It’s a shame when a few scammers can cast a shadow over a largely principled group of professionals pledged to do no harm.

Doctor Owned Device Firms

It’s not easy these days for those who practice medicine. Physicians are standing on shifting sand. It’s a tough and demanding profession. They have to be super smart and go through a grueling educational process that too often leaves them staggering under a mountain of debt. The traditional Fee For Service model that dominates American medicine pushes doctors to see more and more patients and tack on as many services as possible. It’s not a giant leap from there for doctors to have a financial interest in a medical entity or device. Makes sense, we invest in what we know. And there is nothing wrong with that.

But therein lies an ethical and legal quagmire. Let’s say a surgeon specializes in implantable pacemakers and defibrillators. It wouldn’t be unusual to favor and use a particular manufacturer’s models exclusively; nothing wrong with that. The red flags go up when a cozy relationship with the manufacturer evolves into a deal netting the doctor a profit on each device sold. The potential for doctors to call the shots on medical supply purchases is defensible when their motivation is to maintain high quality goods and services. It is indefensible when they have a financial interest.

While blatantly ethically challenged behavior of this nature would seem rare in a profession like medicine, apparently it is common enough to trigger last month’s (2013.03.26) “Special Fraud Alert: Physician-Owned Entities,” from The Office of the Inspector General of the Department of Health and Human Services. Their concern on this issue dates to the late 1980s when they issued their first fraud alert under a statute covering kickbacks in the medical field. While the current alert covers implantable devices, the kickback statute looks at any situation where medical personnel have an interest in a device or facility resulting in usage or referrals that puts money in their pocket.

In addition to the smarmy side of these issues there is an obvious concern that healthcare costs will be driven up by a proliferation of physician owned facilities. Costs driven by an excess number of such facilities where there is little market supply and demand restraint. And when the doctors own the imaging facility, the testing laboratory, the dialysis facility, or any other medical service that they can feed patients into, there is a potential for abuse. It shouldn’t have to be a federal case, but those who will not live within their own ethical boundaries can expect a visit from the law.