“I’m a Medicare doctor. Here’s what I make”

I am certainly not negative when it comes to those who decide to go into medicine as an MD, but I will say that the decision doesn’t seem to be assurance of riches like some used to view it.

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Dr. Schreiber sees 120 patients a week – 30% of them are enrolled directly in Medicare, while another 65% have private insurance plans that peg their payments on Medicare’s rates. Only 5% pay on their own.

Medicare pays between 63-72% of the costs for Schreiber’s patients.

Four billing codes make up the “bread and butter” of claims submitted to Medicare:

– The first code represents a simple visit, which might include blood pressure and cholesterol checks. Schreiber gets about $44 from Medicare for the $70 fee he charges.

– The second and third codes correspond to a sick visit, when he spends 15 to 20 minutes evaluating a patient for symptoms such as coughing or shortness of breath. Schreiber charges $92 for a sick visit, of which Medicare pays about $58.

– The last billing code is a complex visit. “This is where a patient comes in with many problems like heart disease, hypertension, diabetes,” he said. Such a visit requires about 30 minutes of his time.

Schreiber charges $120 for these visits, and Medicare pays $88 of that.

“I’m a Medicare doctor. Here’s what I make”.

–Michael M.

Never Fear…

In India, oversight lacking in outsourced drug trials

So, culturally speaking, I know that “outsourcing” is a pejorative in our language; however, this kind of outsourcing is sad.

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GUJARAT, India – Rambha Gajre was desperate. She and her family faced eviction from their cramped, tin-roof hut if she didn’t soon repay loans she used to cover life-saving medical treatment for her son.

So Rambha did what thousands of other desperate women and men from India’s slums, and across the world, now do to survive — she signed up to be a human guinea pig in drug trials for foreign pharmaceutical companies.

“I am helpless, I have to do this,” she said. “They don’t really force us, but I don’t have a choice.”

Read the full article and watch video from the episode  by clicking the link below.

In India, oversight lacking in outsourced drug trials.

—Michael M.

New transplant method may let kidney recipients live life free of anti-rejection medication

From U of L Today:

by Jill Scoggins, HSC Communications and Marketing — last modified Mar 07, 2012 02:08 PM

New ongoing research published March 7 in the journal Science Translational Medicine suggests organ transplant recipients may not require anti-rejection medication in the future thanks to the power of stem cells, which may prove to be able to be manipulated in mismatched kidney donor and recipient pairs to allow for successful transplantation without immunosuppressive drugs.

Northwestern Medicine^® and University of Louisville researchers are partnering on a clinical trial to study the use of donor stem cell infusions that have been specially engineered to “trick” the recipients’ immune system into thinking the donated organ is part of the patient’s natural self, thus gradually eliminating or reducing the need for anti-rejection medication.

Read the full story here: http://louisville.edu/uofltoday/campus-news/new-transplant-method-may-let-kidney-recipients-live-life-free-of-anti-rejection-medication

–Michael M.

Who You Gonna Call? Ghostwritting Busters!

Blech, that’s the worst blog title ever.

A couple years ago, and while I was still in my undergrad, I was approached by a Ph.D. student wondering if I would write [gender neutral pronoun] dissertation. I said there would be a time when I wouldn’t want to write my own, so I didn’t want to ruin the experience. This article is a bit worse in my book, but it’s timely enough as my ethical research class just finished talking about ghostwriting…

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Critics Respond to Dismissal of Ghostwriting Accusations

Some bioethics experts are criticizing Penn’s dismissal of the research misconduct charges levied by a psychiatry professor against two of his colleagues in the department.

Last July, professor Jay Amsterdam alleged that a paper published in 2001 under the names of Psychiatry Department Chair Dwight Evans, professor Laszlo Gyulai and three researchers unaffiliated with Penn had actually been ghostwritten by a company hired by the manufacturer of the drug that the paper was examining.

A faculty inquiry committee convened by the Perelman School of Medicine concluded that “there was no plagiarism and no merit to the allegations of research misconduct,” according to a statement released earlier this month.

“While current Perelman School of Medicine policy and journal practice call for acknowledgment of the assistance of a medical writer,” the statement read, “the committee concluded that guidelines in place in 2001 did not.”

Eric Campbell, a professor of medicine at Harvard Medical School who studies physician conflict of interest, said it “seems very disingenuous” to dismiss the charges of ghostwriting simply because there were no official rules at the time.

“People in academics know it’s not okay,” he said. “Do you think a student would have been let off? If students know, faculty should know … It’s against the basic tenets of science.”

This article first appeared in The Daily Pennsylvanian (03/11/2012)

Read the full story here:

http://thedp.com/index.php/article/2012/03/after_dismissing_of_ghostwriting

_accusations_critics_respond

—Michael M.

Suck on this: Thank You Campus Health!

–Michael M.

Who is Joseph Kony? Invisable Children Want You to Know.

Do you know Joseph Kony? I don’t, or didn’t before I watched “Kony 2012.” This 30-minute film was produced by the not-for-profit group Invisible Children  to raise awareness about Kony, a Ugandan war criminal taken with destroying the lives of children by abducting them, forcing them to murder their peers and parents, sometimes deforming them physically, and, in retribution for their speaking out, killing the children themselves. I watched Piers Morgan bring the video up in an interview this week with Cindy McCain. Once I made it over to YouTube, I found that in less than 72 hours, the film had been viewed over 15 million times.

These kinds of initiatives are lightning rods for both negative and positive press, and I will admit that the video — in its own way — is a bit like the propaganda it mentions working against. With that said, it worked for me. Do your own independent internet research. You will find folks critiquing the mode and method employed by the filmmaker on both sides of the fence. But don’t miss the message of the film itself. We seem to be living in a time that can be characterized as the Facebook Revolution. And I think that is a truly awesome thing.

—Michael M.

Come Back When You’re Sicker

I want to preface this comment by saying I believe that emergency care and emergency departments (EDs) are, in my mind, expected to deal with patients who treat both like an outpatient clinic. The definition of emergency medicine varies amongst people; my emergency might not be your emergency, and vice-versa. And maybe it is because I worked in a rural system, but I also believe that the access to healthcare – or maybe more so, the lack of access to healthcare – creates an environment where the EDs are clinic-ized simply because people either can’t get to a family doctor because of work or transportation issues or don’t have insurance, so they are unable to pay for a physician visit upfront before seeing a doc in his or her office. Either way, it’s really frustrating when people use EMS (emergency medical services) and EDs for routine or maintenance care.

Clichés are clichés for a reason – they are bound in some form of truth, no matter how trifling it is. A clichéd scenario for EMS is the patient who calls 911 and meets the ambulance in the driveway with a packed suitcase. If anyone spends any time in any capacity in which emergency care is the focus of their careers, this patient will surface. There have probably been a half dozen times in my life where this exact kind of patient – both sexes – have used me as a taxi service. Even more frustrating is when there is a patient who becomes a serial abuser. They’re the kind of people whose address never leaves your mind because you have gone there so often that it becomes a joke. But no matter how frustrating it becomes, you have to look beyond the surface of these patients because, hopefully, there is a reason that can be explained out to serial abusers as to why calling 911 isn’t the best option for them, nor is it the best option for the system.

I had a motto while I was in EMS: I don’t want something bad to happen to anyone, but, if it has to happen, it might as well be while I’m working so I have something interesting to do. Professionally, I used to cuss the serial abusers in my mind from the start if I ended up having to pick one of them up when another truck got to do something fun – like respond to a real emergency. Unfortunately, it happens more than some might think. And certainly EMS professionals are the last people to send on a run where the patient needs to get to the hospital because of a bunion or because they’ve ran out of furosemide. We are way too high-strung for that kind of thing. And I myself am completely guilty of lecturing patients about ED/EMS abuse. When emergency patients are pushed back because an ambulance that would be closer to their location is transporting someone who clearly doesn’t need an ambulance, or whom doesn’t need to be an ED walk in because their wrist has been hurting for six weeks and they decided that 10:00 PM on a Sunday was the best time to seek out treatment, those are the moments when I wanted to take these patients to the ED and show them a vent patient with CHF or someone packaged on a backboard whose best friend was killed in the same accident not more than an hour before. But I didn’t, because that is the nature of the beast, and it is one hell of a strong beast to have to contend with. This relationship is further complicated when patient’s fail to establish a primary care physician. There is no continuity of care when an emergency department physician is used for health maintenance. Because of this lack of continuity, the serial abusers might solicit EDs more often than those whom have a primary care doc because the role of the ED physician is grounded in the here and not, not in the idea that six months from now, the serial abuser’s care needs might shift dramatically.

Have we arrived at a time when patients who present to the ED for ailments that can be treated by primary care doctors should be turned away if they don’t meet a specific level of acuity? Primary care has having three foci, and this foci is what differentiates primary care from secondary or tertiary care: duration, frequency, and level of intensity. Primary care physicians may have the same patient pools for years and years. This is especially true of primary care physicians who set up office in a rural setting. It is possible that a primary care doc could see the same patient for upwards of thirty or forty years, specifically if neither the patient nor the doc ever plans on leaving the area both live and work. There is also the possibility that a primary doc can see multiple generations of the same family, again especially in a rural setting. And although specialty doctors can have long relationships with the patients – especially in fields like cardiology or pulmonology – where life-long maintenance is required for positive health outcomes, the frequency in which the specialty doctors and their patients see one another is a fraction of the time primary care physicians see their clientele. Primary doctors treat a host of condition within the spectrum of their practices, and the more care that can be executed by the primary care provider, the greater the frequency is going to be for when they see their patients. As for intensity, primary care providers are expected to provide patient education, maintenance of long-term health plans, the evolution of the patient through their lifespan and the trajectory of diseases over the course of as lifetime. This is unrivaled in any other arena of medicine.

And this is a testament of sorts as to the importance of primary care physicians as the “gatekeepers” or conduit of specialty care referrals. In a well-executed system, the primary care physician knows his or her patient like no one else. It’s this level of both intensity and intimacy that helps the primary care physician match their patients with the right kind of specialty care. Good primary care physicians know when the acuity and needs of their patients become too high for their level of practice. A good gatekeeping physician allows the patient to know when he is surpassing the scope of primary care practice. Once the scope of practiced has been reached, gatekeeping primary care docs help their patients make good decisions as to who and where the next step in the patient’s overall care needs to be focused.

Bioethics in Film: The Darren Aronofsky Edition

Okay, so I am a bit of Darren Aronofsky fan. I love how he has a way of breaking characters down to show the movie-goer just how fragile the mind can be. So if you are a fan of how religion and science constantly influence psychology and terrible decision-making, I offer the following five films:

The Fountain follows three non-liner timelines set in the past, present (2006), and future. All three stories are told through narratives played out by Hugh Jackman. The common thread is death – both by accepting it and by yielding to. The movie is a slow burn, and I have to say I hated it the first time I watched it. However, I have grown to see it as something special, and for those who have taken the death and grief course with Dr. Head, you-all might catch an all but direct quote in the movie taken from one of the books used in the class.

Natalie Portman is astonishing in Black Swan playing the character of Nina Seers – a woman who may or may not be losing her grip on reality. The ambiguity of the narrative helps to foster the is-she-or-isn’t-she depth of Nina’s psychological struggles. Fans of Jungian psychology will have a field day with Aronofsky’s script. And as a film buff, I have to say the last 20 minutes of the film are nothing short of brilliant.

Aronofsky has stated in interviews that he feels his work in Black Swan is a companion piece to his film The Wrestler staring the enigma known as Mickey Rourke.  The film follows the life of Randy “The Ram” Robinson and his search for meaning as it relates to his life by analyzing the motives for his existence. Much like Portman in Swan, Rourke is never better than he is playing a character that, in many ways, represents who the actor is in real life.

Ever watch a movie that makes you feel terrible about the world in general once it’s over? If you haven’t, Requiem for a Dream might fill that gap in your life. Much of the movie explores the vanities we struggle with in life and how those vanities begin to warp our minds and the world around us. Aronofsky uses sex and drug addition as a means to propel his characters to a dark place we should only hope to never find ourselves.

Pi – Darren Aronofsky’s first full-length feature – is some business. It’s an experimental look into either the mind of a mathematician chasing the ultimate proof or the delusions of a man ruined by his own genius. At times the movie feels really Film School 101, but, for the most part, the director does an amazing job of translating what it might feel like if everything you ever saw was somehow tied to a combination lock you just can’t seem to crack.

— Michael M

Officials Organizing Volunteers to Assist Tornado Victims

Preface: For those that might be interested in volunteering in the Henryville community. I was thinking this might be a good future opportunity for the BETH group that is currently forming.

HENRYVILLE, Ind. (AP) — Officials said Sunday they soon hope to allow more volunteers into the southern Indiana towns hit hardest by devastating tornadoes that killed more than a dozen people in the state.

Emergency officials have discouraged untrained volunteers from traveling to the Henryville and Marysville areas since Friday’s storms because of dangers from downed electrical lines and leaking natural gas lines. The tornadoes packed 175 mph winds.

The number of victims who died in Indiana as a result of the storms reached 13 with Sunday’s death of 14-month-old Angel Babcock at a Louisville, Ky., hospital. The child’s father, mother and two siblings also died in the storm. Earlier Sunday, the state Department of Homeland Security had reduced the number of deaths in Scott County down to one from the three previously reported.

All the deaths happened in rural areas of southern Indiana about 20 miles north of Louisville, Ky. State police Sgt. Jerry Goodin said officials believed they had accounted for everyone in the small towns hit by the tornadoes.

Authorities were concentrating on keeping the area secure from looters and outsiders looking to gawk at the destruction in the perhaps 50-mile-long strip cut by the twisters.

A volunteer coordination center was scheduled to open Monday in nearby Jeffersonville, where those who want to help out are being asked to register and be assigned tasks, Goodin said. Progress by utility crews on making repairs has officials believing those volunteers will be allowed in Monday, he said.

“Since the very first night, it’s been overwhelming the number of people from all over who are wanting to come in and help,” Goodin said.

About a dozen local volunteers worked midday Sunday at the Henryville Community Center, cooking food for residents and preparing donated food and bottled water for distribution.

Clark County REMC said it didn’t know how long it would take to restore electricity throughout the area, where some 2,800 homes and businesses remained without power Sunday in and around Henryville and Marysville. The utility said it had nearly 8,000 outages following the Friday afternoon storms.

Crews from other utilities are helping to replace dozens of poles, string new wire and trim trees, and the company’s power supplier estimates it could take a week to rebuild the substation and transmission lines in the Henryville area, the utility said.

Scott County Sheriff Dan McClain said the difference in the county’s number of fatalities might be due to an initial report that an elderly couple was missing after a tornado hit near the small community of Nabb, destroying about 20 houses and mobile homes. They were later found safe.

The county’s one fatality was a man who lived in a trailer that was blown across a county road, McClain said. The man was found alive but died at a hospital.

This story was taken from http://www.wane.com on March 5, 2012, and can be found by pasting this link: http://www.wane.com/dpp/news/indiana/officials-organizing-volunteers-to-assist-tornado-victims

–Michael M