Hippocrates and His Kin

Current Issue

Sophisticated terrorists with a sense of humor?

When al-Qaida-style insurgents overran the northern city of Mosul, among the war booty they seized were what they claimed were five U.S.-made helicopters. Noting that they were still nearly new, the group said in a posting on its Twitter feed, “We’ll expect the Americans to honor the warranty and service them for us.”

You think Obama may just do that?


The insurgents from the Islamic State of Iraq and Syria are sophisticated extortion racketeers in Mosul netting as much as $8 million a month. Once they are in charge, they typically levy taxes which are just as lucrative. Road taxes of $200 on trucks are collected all over northern Iraq to allow them safe passage. The Iraqi government says they are levying a tax on Christians in Mosul to avoid being crucified.

They must be trying to change their image from casual executioners to standard government practices.


Miss Manners is weighing in on Business Letters.

Dear Miss Manners: I like Best Wishes or Best Regards to end business correspondence, but I’ve been toying with alternatives for friends and family: “Live Healthy,” “Live free,” “Live well,” “Be well,” “Be safe.” Etc. Am I creating a trend perhaps not respectful of traditional (manners)?

Dear Gentle Reader: When traditions need improving, Miss Manners will let you know. There is nothing wrong with signing off with assurances of sincerity or good wishes or affectionate sentiments. Admonishing your correspondents to lead safe, healthy lives sounds remarkably like nagging.

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Hippocrates and His Kin / Hippocrates Modern Colleagues
The Challenges of Yesteryear, Yesterday, Today & Tomorrow

 

Hippocrates and His Kin

Previous Issue

Hippocrates would not have survived today. But will his kin?

Blood Tests, Anyone?

With the recent survey of variations in charges for a Lipid Panel to measure your cholesterol, triglycerides, LDL, HDLs, etc. from $10 to $10,169, calls for more regulations of the laboratory industry  are everywhere. But these prices are the result of regulations. If we got the government, Medicare, Medicaid, and other middle men out of health care, just think what would happen. No patient in his right mind would pay those prices. In fact, sometimes some of my patients don’t think knowing their cholesterol is even worth $10. All those hospitals and labs that are charging more than $100 would go out of business within 30 days. What a neat way to trim health care costs. Permanently! Maybe that would also trim health insurance to only costly items. Remember the days when Blue Cross only covered expensive items like hospital admissions. Then Blue Shield was invented to cover surgery. Then we lost sight of what insurance was for. Now patients are asking for prescriptions to cover aspirin and vitamins.

What a back door approach to cover chump change!

* * * * *

Has Medicare Made a Difference?

In 1964, a year before Medicare passed, seniors were paying 20% of their income on health care.31

In 2000, a study by the American Association of Retired Persons (AARP) found seniors paying about $2,510 per year - 19% of their income - on out-of-pocket costs.30 This does not include home care or nursing home care.

Since our personal HealthCare costs are the same before and after Medicare, how do we extract ourselves from the high cost of Medicare?

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Hippocrates and His Kin / Hippocrates Modern Colleagues
The Challenges of Yesteryear, Yesterday, Today & Tomorrow

 

Hippocrates and His Kin

Past Issue

Obamacare may be the most important issue in the next election

            Obama is losing members of his own party on multiple fronts including draconian EPA rules:

Leon Panetta, CIA director and defense secretary, has been blunt about the president’s mismanagement of the Middle East . . . after drawing a “red line” that would require the use of force against Bashar Assad if he used chemical weapons: “When the president of the United States draws a red line, the credibility of this country is dependent on him backing up his word.”  [He didn’t]

Rob Ford, former ambassador to Syria, resigned in March and told CNN: “I was no longer in a position where I felt I could defend the American Policy.”

Senator Dianne Feinstein, Senate Intelligence Committee Chair, once a staunch Obama supporter has become increasingly unhappy over the administration’s lack of communication with Congress about the National Security Agency’s surveillance practices; disturbed that Congress was out of the loop regarding the exchange of five Taliban commanders to win the release of Army Sgt. Bowe Bergdahl. 

Senator Mary Landrieu, Louisiana, has spoken out against the EPA rules that will severely punish coal-fired plants and endanger jobs.

Alison Lundergan Grimes, Democratic Senate candidate for Kentucky, has pledged to fight what she calls Mr. Obama’s “attack on Kentucky’s coal industry.”

Nick Rahall, West Virginia Rep, says that the EPA rule shows “disregard for the livelihoods of our coal miners and thousands of families throughout West Virginia.”

Max Baucus, former Senator, call the law a “train wreck.”

Sen Jay Rockefeller says the law is “beyond comprehension.”

Joe Garcia, Florida Democratic Congressman, is running for re-election by openly bashing ObamaCare.

Democrats have increasingly resisted the president’s judicial Picks including Michael Boggs and Mark Cohen, who blocked Vivek Murthy, Obama’s surgeon general appointee; and killed the nomination of Debo Adegbile, his appointee to head the Justice Department’s civil-rights division.

Nancy Pelosi, House Minority Leader, promised that Democrats would run on ObamaCare in November.

Many are not listening

Americans may still reject ObamaCare and save American Medicine, the world’s most advance Medical Care.

Read more of Douglas Schoen (political adviser for Pres Bill Clinton) in the WSJ . . .

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Hippocrates and His Kin / Hippocrates Modern Colleagues
The Challenges of Yesteryear, Yesterday, Today & Tomorrow

 

Hippocrates and His Kin

Past Issue

The current drought; Administrators get paid more than physicians

Mechanic to doctor wearing hearing aids picking up his car: “I couldn’t get your brakes fixed so I made your horn louder.”

The California Drought

Cartoon in the Sacramento BEE: Two men with guns approach a lady watering her lawn: YOUR GRASS DIES OR YOU DIE. 

Administrators Get Paid More

So not only are there more administrators than doctors but it turns out they get paid more too. “The base pay of insurance executives, hospital executives and even hospital administrators often far outstrips doctors’ salaries, according to an analysis performed for The New York Times”. When someone asks you what is wrong with our healthcare system you can start by pointing this out. Personally, I want to puke.

C.E.O. of health/disability insurance firms:                 $583,700
Hospital C.E.O.:                                                                  $386,000
Hospital administrator:                                                    $236,800
General physician:                                                             $185,000
Family-practice physician:                                               $165,300
Physical therapist:                                                              [TEXT]nbsp; 78,100
Audiologist:                                                                          [TEXT]nbsp; 72,600
Staff nurse:                                                                           [TEXT]nbsp; 61,900
Emergency medical technician

COMMENT

Bill Ameen

These figures are right on and a national disgrace. The teaching hospital closest to us (we’re owned by another one) just laid off another few hundred after 900 last year. The CEO, surprisingly a doctor, makes >$2,300,000 including his perks like country club membership. He should be ashamed to show his face in public except, of course, at the country club! (Our owner is laying off quite a few too but of course none at the upper echelon. Seems like a MBA is a magic shield.)

John Stewart, MD

Speaking of non-docs making a lot of cash, did you notice this week that our old buddy John Edwards is back at what he does best-suing doctors. Thirteen million dollar settlement.
Maybe he can afford another love child with a cinematographer while he runs for president.
World’s richest ambulance chaser, and to think he aspired to be the leader of the free world.

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The Challenges of Yesteryear, Yesterday, Today & Tomorrow

 

Hippocrates and His Kin

Past Issue

Telehealth

Will Telehealth replace the traditional office visit?

Liam Woodard National Director, Academic Division |Top Contributor

82% of Young Adults Would Prefer Telehealth to In-Person Visit beckershospitalreview.com

A new study from MDLIVE, a telehealth software provider, has found the vast majority (82 percent) of young adults age 18 to 34 say having a consultation with their physician via a mobile device is the best option for them.

Everet Taylor, MA, MPM, PMP© Clinical Project Manager at Independent Contractor

Very interesting! The 18 to 34 age group are not alone, I have met with seniors that rave over telehealth as well. The evidence of its value can be seen in the very rural areas once it gets there.

Ramsey Carol VP of Rehabilitation at Pinnacle Healthcare Inc.

As a PT with a disabled husband at home, telehealth would be an excellent option for his frequent physician visits! Often the working spouse must take off work, and assist with transport and this is taxing the spouse and their employer when a telehealth option could even be a 3-way conference and allow me to join that visit from my workplace, and my husband from the comfort of his home. If I can remotely monitor him at home via the internet, the physician should be able to as well for routine visits.

What is the biggest obstacle to Telehealth? How would we pay for it? --Editor’s comment

There are essentially two ways to pay for health care. One is to personally pay for it in a Free Enterprise fashion. As more physicians would do this and competition increases, the cost would decrease. It would then be affordable. The cost is estimated at about one-half our present health care costs.

The other method is to try to convince CMS, Medicare, Medicaid, Blue Cross, and Blue Shield, to pay for Telehealth. This would set up a bureaucracy in each of the above payment schemes with the cost being added to the basic cost of a physician responder who would conduct the medical interview and prescribe the treatment. This could only be done on patients calling their personal physician since having a valid medical file is a requirement of most licensing boards. In California, this is defined as having a recorded medical history and physical examination within the past one year. With the bureaucracy of numerous insurance companies, each would have to verify that this medical visit had occurred. This would create a huge burden on each physician’s office. In our studies on the time involved to provide this data, it would come to about one-half of an office visit charge or about 10 minutes.

With the advent of hospitalists, their obtaining medical data from our office on our patient’s admission plus our obtaining of the hospital medical data on our patient’s discharge, reviewing the medical information and incorporating this into the patient’s electronic medical records also takes about one-half of an office visit or 10 minutes of a 20 minute appointment. Since this is also not a reimbursable expense; it is a cost reduction in the physician’s income.

From the data obtained from physicians who do not accept insurance and thus eliminate billing, the savings is about 50%. From the patient’s perspective, having insurance, which eliminates market forced efficiencies, doubles the cost of health care which is painless to the patient.

The majority of patients, as well as physicians cannot remember the one and two dollar office calls of the 1950s and sixties, and thus can’t comprehend personalized health care. In the UK with the NHS now being nearly 60 years in existence, there are no physicians who have been in practice that long. Hence, to propose private practice efficiency would be considered pure lunacy, not only by the patients, but also by the physicians having no longer experienced such an efficient system.

The return to personalized private cost-effective healthcare is no longer a goal of current practicing physicians or the current patients or public. It could only happen if the initial startup funding was outside of the public or physician’s purse since the opposition would be nearly universal. Current physicians even in the United States would fear the risk.

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Hippocrates and His Kin / Hippocrates Modern Colleagues
The Challenges of Yesteryear, Yesterday, Today & Tomorrow

 

Hippocrates and His Kin

Past Issue

The fee-for-service model is not what broke the system

Healthcare Executives Network

Grace Cleaves • The Forbes article describes this ironic paradigm: we needed our docs to be excellent clinicians and we trained them to do that. Now we need them to be business savvy change leaders. We didn't train them to do that. We wanted them to know how many bones were in our hands, not how to read a P&L. We ask a lot of our physicians, including urging the transition to embrace leading and entrepreneurship in their set of tools.

George Burns • The fee-for-service model is not what broke the system, it is just a coincidence.
What broke the system was time and the economic downturn. A medical practice or a hospital etc is a business and should be run like one in order to survive. However, medical practitioners are not business people and cannot run a business.

Many practices were started in boom times when money was easily available and at low interest rates. HMO were dishing out money under the capitation model. The money was good.

But then the VC money dried up (HMO failures, New Century bankruptcy etc) and the insurers started reigning in those whose capitation balances had become unmanageable etc. There was a brief pause with Medicare Part D, but after a while the trend continued. Then came the economic downturn, and after 5+ years of it, medical practices etc are facing the same difficulties that are facing all other small businesses. There is no rational reason to think that medical practices are not small businesses.

* * * * *

Arlen Meyers, MD, MBA • To thrive, doctors need to practice Othercare. That means:
1. Leading change
2. Manage their practices efficiently and effectively
3. Adopting an innovative and entrepreneurial mindset
4. Using non-face-to face and alternative care delivery models using digital health technologies
5. Consolidating to take advantage of efficiencies of scale and the elimination of fee for service medicine

There is increasing pressure on medical schools to teach this stuff. Otherwise they are teaching their graduates to fight the last war with blanks in their rifles before sending them over the top.

* * * * *

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The Challenges of Yesteryear, Yesterday, Today & Tomorrow

 

Hippocrates and His Kin

Past Issue

Ants, Scars, and Corkscrews

Doctor:  “You’ve simply got to have more diversion and relaxation in your life.”

Patient:  “But, Doctor, I’m too busy.”

Doctor: “Nonsense! The ants are hard-working creatures, but they always take time to attend all the picnics.”


“Oh, doctor,” said the young lady, “will the scar show?”

“That, madam,” said the doctor, “is entirely up to you.”


The town doctor was in bed when his phone rang and an excited voice told him that the baby had swallowed a cork screw. The doctor was about to leave for the patient’s home when the phone rang again.

The same voice came on the line and said: “It’s all right now, doctor. We’ve found another corkscrew.”

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The Challenges of Yesteryear, Yesterday, Today & Tomorrow

 

Hippocrates and His Kin

Past Issue

A Common Ancestry; A New Way to Stop Smoking

If all the countries of Europe had a common ancestor only 1000 years ago, maybe we all had a common ancestor some 6,000 years ago?

Suppose their names were Adam and Eve?

Adam and Steve could never have produced such a family. You can’t reproduce hooking up to the rectum. You can’t even have a face to face meeting that way. One would throw his spine out of joint to try to get an approval from Medicare without a face-to-face meeting, wouldn’t he?

When God made Woman after creating all the other mammals, He greatly beautified creation by moving the mammary glands from the groin to the top of the chest. He also made marital union far more pleasant and exciting.

Can you imagine watching the Academy Awards with all those beautiful women with their gowns draped around breasts still in the groin?

Ella Mae Lopez in Sacramento was sentenced to 63 days in jail for slapping Deputy Matt Campoy as he excited the main jail in uniform at the end of his shift. Lopez kept blocking his path as Campoy tried to avoid her until she finally slapped him in the face. Lopez explained she was only trying to serve time in a smoke-free jail in order to quit smoking cold turkey.

Sixty-three days of not smoking is probably about the same success that smoking withdrawal clinics achieve.

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Hippocrates and His Kin / Hippocrates Modern Colleagues
The Challenges of Yesteryear, Yesterday, Today & Tomorrow

 

Hippocrates and His Kin

Past Issue

GOP senator backs same-sex marriage

U. S. Senator Rob Portman, is the first GOP senator to back same-sex marriage, after announcing that he has a gay son and could no longer justify his opposition to same-sex marriage. That statement, in and of itself, would normally remove him from any objectivity in the debate. He was a sponsor of the 1996 Defense of Marriage Act, which was reviewed by the Supreme Court. That case, he said, was a factor in his decision to speak out.

Or is this a factor in delaying his “coming out of the closet” announcement?


Britain investigates price fixing for the Shock Absorber Bra

The Shock Absorber Bra was once advertised by tennis player Anna Kournikova under the slogan: “Only the balls should bounce.” It is now being investigated for price fixing.

Was it really that the “price that was fixed” or that the “mammae were not fixed?”

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The Challenges of Yesteryear, Yesterday, Today & Tomorrow

 

Hippocrates and His Kin

Past Issue

Now we know why the Editor of Medical Tuesday was targeted.

Several years ago the editor of MedicalTuesday received a notice of a tax audit alleging an under payment of an amount that equaled 90% of his income that year. After six months of researching files with my CPA, essentially all of the charges were reversed. How could the IRS come up with any reasonable idea that 90% of my deductions, which were essentially the same over many years, should be disallowed?

This was obviously a targeted audit.


CEO of Starbucks, tells Christians, to sell their Starbucks stock.

Steven Schultz, CEO of Starbucks, told Christians, if they don’t like his stance on Gay marriage, to Sell their Starbuck Stock and take their business elsewhere. He said the current 10% drop in his stock price was just a normal variant. Many of us that normally visited Starbuck have followed his advice and have switched to Peet’s Coffey.

A recent walk by the normally very busy Starbucks across from my office found three workers not working. No one was in line for coffee either. You suppose the coffee crowd is taking his advice?

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The Challenges of Yesteryear, Yesterday, Today & Tomorrow

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