Physicians, Business, Professional and Information Technology 

Networking to Restore Accountability in HealthCare & Medical Practice

MedicalTuesday, Vol IV, No 2, April 26, 2005

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MedicalTuesday refers to the meetings that were traditionally held on Tuesday evenings where physicians met with their colleagues and the interested business and professional communities to discuss the medical and health care issues of the day. As major changes occurred in health care delivery during the past several decades, the need for physicians to meet with the business and professional communities became even more important. However, proponents of third-party or single-payer health care felt these meetings were counter productive, and they essentially disappeared. Rationing, a common component of government medicine throughout the world, was introduced in the United States with Health Maintenance Organizations (HMOs), under the illusion that this was free enterprise. Instead, the consumers (patients) lost all control of their personal and private health-care decision-making, the reverse of what was needed to control health care costs and improve quality of care.

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In This Issue:

1.    It's Called Patient (Consumer) - Directed Personalized Health Care – and It Works.

2.    Health Care Billionaires - College Dropouts, Attorneys, and One Physician

3.    An American Epidemic Invading Europe

4.    This Week’s Review of Corporate Socialized Medicine - HMO Medicine

5.    Medical Gluttony: Why Does Insurance for Four in Kansas City, MO., Cost About $170 per Month While Similar Coverage in Boston Tops More than $750 a Month?

6.    Medical Myths - Do As Your Attorney Says - Don't Talk to Your Patient

7.    Overheard in the Medical Staff Lounge - Don't Follow Your Attorney's Advice

8.    The MedicalTuesday Recommendations for Restoring Accountability in Medical Practice, HealthCare and Government

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1.    It's Called Patient (Consumer)-Directed Personalized Health Care – and It Works.

A number of insurance companies are jumping on the band wagon to cost-effective health care. We do not endorse any specific products, but we thought some recent ones that caught our eye might be of interest to MedicalTuesday readers.

Definity Health feels the path to better health and more cost-effective health benefits can be found at Definity Health where ". . . we’ve left behind the managed care principles of restrictions, red tape and bureaucracy and embraced the power of freedom, education and support to create a totally new health benefit. We call it Consumer - Driven Healthcare – and it works.

"It’s a simple yet radical concept: The patient or consumer of health care services, are given direct access to their health care dollars and the freedom to make choices that align with their needs and values. As a result, the patients are more satisfied with the outcomes achieved – and ultimately more cost-conscious – expecting better service, quality and value in exchange for their health care dollar." Visit their website at http://www.definityhealth.com/marketing/index.html.

Launched in May 2000, "Destiny Health is a health insurance company founded on a revolutionary concept - putting its members in control of their own health care dollars." The Destiny Health plan design motivates ". . . active participation in health care and rewards the member behavior changes necessary for a healthier lifestyle. . . . The Destiny Health model is a health insurance solution for those who seek greater value, superior choice, outstanding service and comprehensive coverage."

The Destiny Health Plan currently has more than 50,000 members and 900 employer groups enrolled in the U.S. Visit their website at http://www.destinyhealth.com/index.jhtml.

Fortis Health, which was the first to write an HSA product on January 1 of last year, the first date it was available, has now become Assurant Health. As they continue with their unique HSA plans, they have added a large variety of health products for the individual, the family and the small employer. Visit their website at http://www.assuranthealth.com/plans/great_new.shtml.

MedicalTuesday is working with a nucleus of professionals and startup entrepreneurs on a model that replaces the managed care principles of restrictions, red tape and bureaucracy as well as a motivation program that rewards behavioral changes necessary for a healthier lifestyle based on the simple concept of premiums geared to the present lifestyle. We feel that a patient whose insurance premium reflects risky or gluttonous behavior will modify that behavior or change that lifestyle with no bureaucracy in place. The working model, HealthPlanUSA, projects a premium of $100 a month for the third decade of life as the baseline average. If a two-pack-per-day cigarette smoker has an average health care cost exceeding the normal by 120 percent, his premium would be $220 a month instead of $100 a month. It is our theory that the smoker paying $220 a month will have greater incentive to stop smoking than what is provided by all the cigarette withdrawal programs available. He will progress much faster to a healthy life-style in order to reduce a premium, rather than other monitory rewards. If the overweight individual with a Body Mass Index (BMI) of 35 (Normal 20-25) has a 65 percent higher health care costs, a premium of $165 would be required. Similarly, we feel this will motivate the obese person to lose weight much faster than trying all the thousands of dietary programs available today. The need for behavioral changes will be reemphasized with every monthly premium payment. It is our belief that this single factor will do more to change the overweight epidemic surging across our country, affecting upwards of 60 percent of the population, than all the educational and motivational programs combined. An increase in one’s health insurance premium is the single most effective motivation.

Major impediments in making insurance affordable are the numerous insurance mandates that, rather than help patients, provide politicians a feeling of serving some special interest at the expense of the general public. Some of these mandates may prevent portions of the HealthPlanUSA model to be marketed. If all mandates could be repealed, the health-care problem in our country would essentially be solved, and we would march on to greater health and further reduction in health-care costs for everyone.

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2.    Health Care Billionaires - College Dropouts, Attorneys, and One Physician

Forbes has released the names of the 15 health care entrepreneurs who have joined the ranks of the billionaires. These include people with high school diplomas, college drop outs, college graduates, lawyers and one physician, Thomas Frist ($1.7 bn), father of Senator Frist. Dr Frist made his fortune in Hospital Corporation of America. He came out of retirement to nurse HCA through an extensive Medicare Fraud investigation and has since retired again. Predictions are that his second retirement will go more smoothly.

Topping Forbes’ list are John Abele ($5.4 bn) who, with Peter Nicholas ($4.7 bn), co-founded the medical device firm, Boston Scientific, manufacturer of devices designed for minimally invasive surgery, including catheters, stents and balloons. Stock has surged thanks to a promising drug-coated stent now available in Europe, but still awaiting FDA approval in U.S.

There are 14 health care billionaires from the United States and one from Monte Carlo, Monaco. To review the entire list, go to http://www.forbes.com/lists/results.jhtml?passListId=10&passYear=2004&passListType=Person&resultsStart=1&resultsHowMany=25&resultsSortProperties=%2Bnumberfield1%2C%2Bstringfield1&resultsSortCategoryName=rank&category1=Industry&searchParameter1=5Str%7C%7CPatCS%7C%7CHealth+Care&category2=category&searchParameter2=unset.

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3.    An American Epidemic Invading Europe

A Wall Street Journal article last week, French Women Do Get Fat, indicates that the American epidemic of obesity is invading Europe.

That's the finding of new research out last month on the European diet. In terms of expanding waistlines, Europeans are catching up to and even surpassing the U.S. Most European Union countries show a rise in obesity across all segments of society, according to the London-based International Obesity Task Force, a coalition of scientists advising the EU.

Germany, Finland, Greece, Cyprus, the Czech Republic, Slovakia and Malta have a higher share of overweight men than the U.S. Among women, only Greece's obesity rate (38%) tops America's (34%). Though the U.S. still takes the cake overall, the gap is narrowing. European children in particular are getting plumper: More than 30% of Spanish, Portuguese and Italian children between the ages of seven and 11 are obese or overweight.

Not even the nation with a claim to its own "French paradox" -- eat rich, stay lean -- is immune. "Obesity: A New French Illness" is the name of a book out recently by a French doctor and parliamentarian, who reports that 19.8 million of his compatriots are overweight, including 35% of French women. So much for the premise of Mireille Guiliano's best-selling diet book in the U.S., "French Women Don't Get Fat." In Paris, obesity is up 70% since 1997.

Another new book in France carries the charming title, "50 Good Reasons to Detest Americans." No. 15 is la gastronomie, as illustrated by cartoons of super-sized Yanks eating hot dogs and sipping mega-Cokes. But it sounds as if this cultural condescension is also out of date: The EU and America may soon be competing to cut calories, as well as tax rates. Please see the original article at http://online.wsj.com/article_print/0,,SB111318166672703115,00.htm.

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4.    This Week’s Review of Corporate Socialized Medicine - HMO Medicine

The Health Maintenance Organizations (HMO) work through Managed Care Organizations (MCO) to reduce their payments to hospitals, physicians and other providers to the lowest possible cost. I attended one of their quarterly meetings last week. Because more patients are becoming unhappy with their HMO physicians, the theme of this meeting was how to keep patients happy. In the absence of an HMO, most physicians organize their practice in order to keep all their patients happy which provides incentive for the patients to return. Now the tables have been turned because the patient has no alternatives except to use an HMO panel doctor, no matter how terrible the doctor or service may be. There is no incentive to be the best because the worse doctor gets paid the same as the best.

I thought the response to the clinical problem given that night illustrated how far the younger physicians have been compromised. It reminded me of a meeting I attended in London concerning physicians in the National Health Service (NHS) which is now more than 50 years old. Few physicians in the UK can remember taking care of patients in the private atmosphere of a competitive practice, where patients that are not happy with the service provided fail to return.

The clinical problem handout was straightforward. A patient with a family history of diabetes is concerned whether he has diabetes. His doctor orders a glycohemoglobin. (This test gives an estimate of the average blood sugars over the previous 24 hours. It has replaced the glucose tolerance test.) The patient returns to the office and complains to the physician that her three phone calls didn't provide her with the results of the test.

Every physician at the meeting solved this problem based on the doctor’s office being at fault. The physicians stated that after the apology, they would investigate to find who was at fault, severely reprimand that individual, and begin an office procedure and training program to make sure that this would never happen again. In short– put the entire office on notice, making them extremely tense and concerned about their job and not fully understanding that perhaps no one made an error, while probably increasing the repeat-error risk.

Knowing that because of the HMOs, most laboratories are getting reimbursed at approximately one-fifth of their costs, my response was to apologize to the patient that the HMO system has caused a delay in reporting. Our office has prevented those three patient phone calls by informing them that instead of "next-day" results, like in the days of private medicine, it will take three to five days and, therefore, there is no need to call for a week after they go to the laboratory. (My wife's physician recently requested laboratory tests in which the insurance carrier indicated $264.30 of the fee was unnecessary and paid only $58.70. This obviously precludes first-class, next-day service to which doctors and patients had become accustomed prior to the era of the HMOs, a government incentivized program.)

It is indeed tragic that doctors have bought into the concept of their being the culprit of the health-care crises, the delays, the errors, the insensitivities, etc, et al, and respond as if they, indeed, are responsible. It is simply that HMOs have transferred their problems to the physicians and are spending time and resources to train and convince physicians of their error–when in fact it is the HMO that created the problems in the first place.

Government is not the solution to our problems, government is the problem.

Ronald Reagan

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5.    Medical Gluttony: Why Does Insurance for Four in Kansas City, MO., Cost About $170 per Month While Similar Coverage in Boston Tops More than $750 a Month?

Gluttony, or excessive health insurance costs, may have nothing to do with the health industry or the insurance industry. It is caused by the legislatures and congress requiring insurance coverage for nonexistent medical liability. Why should a family be required to have maternity coverage if it is impossible for any member to become pregnant?

David Gratzer reports in The Wall Street Journal on a Simple but Effective idea. Allow interstate sales of health insurance. It won't cost a penny from the treasury. And it allows individuals to bypass states with excessive mandates.

Insurance premiums vary greatly from state to state. Last month, eHealthInsurance, a leading online insurance brokerage, compared the cost of a standard family insurance policy ($2,000 deductible with a 20% co-insurance) across the nation's 50 largest cities, involving some 4,000 insurance plans and 140 insurance companies. Some results are startling. Consider: a non employer-based family policy for four in Kansas City, Mo., costs about $170 per month while similar coverage in Boston tops more than $750 a month. Unpublished data on the small group market - which serves smaller companies - also suggests great variability: Similar HMO coverage for a business in New Jersey is a third more per employee than in California.

Why the price difference? Many states dictate the type of services and providers. New York, for instance, requires that the services of a podiatrist be covered. Acupuncturists are mandated in 11 states, massage therapists in four, and chiropractors in 47, driving up the price of even the most basic insurance plans.

Some states have gone further. Laws force insurers to sell to any applicant (guaranteed issue) and at the same price, regardless of age or health (community rating). Faced with higher premiums for insurance they seldom use, the young and healthy drop their coverage, leaving an insurance pool of older, sicker people -- and even higher premiums. After a decade of such political meddling, the average monthly cost of a family policy in New Jersey bests the monthly lease of a Ferrari. In such an environment, many insurance carriers choose not to do business; in Vermont, for example, just three companies sell to the individual market.

The consequences according to Gratzer: Higher premiums. More uninsured. Reduced labor mobility.

A remedy? Some suggest massive tax credits and other subsidies, an unlikely possibility in light of the budget deficit. An alternative would be to allow out-of-state purchases of health insurance. The federal McCarran Ferguson Act of 1945 empowers states to regulate "the business of insurance." Nothing prevents Congress, however, from allowing interstate sales. The foundation of such a bill would be the Constitution's Commerce Clause. Individuals and small businesses would then be able to shop around and find a low-cost policy - an affirmation of free market principles since interstate restrictions now leave many Americans at the mercy of a small number of local health insurance carriers."

Gratzer concludes that allowing a competitive market for health insurance won't be a major budgetary expense -  but it may prove priceless to the cause of advancing market reforms to better American health care. See Gratzer’s entire article at http://online.wsj.com/article/0,,SB110661643244934843,00.html.

Dr. Gratzer, a physician, is a senior fellow at the Manhattan Institute.

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6.    Medical Myths - Do As Your Attorney Says - Don't Talk to Your Patient

Angelo C. Mendez, MD, reports that when he was threatened by a malpractice claim over a "foreign object" in a former patient, he fought back - and stopped the suit before it started.

"It all began innocently on a warm summer day in 2002, when I received a request from an ob/gyn in another city for records on a patient I'll call Mrs. Vail. She had apparently moved away, and was changing doctors. Although I hadn't seen her in more than eight years, I still remembered her: a very nice woman with extensive endometriosis. I had done a laser laparoscopy on her in 1990, and she'd had a good recovery. In 1992, however, Mrs. Vail had returned with increased symptoms, and we'd elected to do a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Again, the surgery and the recovery had gone well. I recalled that she'd brought me a bottle of fine Merlot as a gift on one of her post-op visits.

". . . All of this rushed through my head as I read the letter from Mrs. Vail's attorney. It claimed that I'd left a "blue cap" inside her abdomen during her laparoscopy in 1990, and demanded a payment of $250,000. If I didn't respond in 60 days, a lawsuit would follow.

". . . I called my personal attorney and told him about the letter. I asked him to call Mrs. Vail's lawyer and set up a meeting with him to get more information. Then I called my malpractice carrier and discussed the case with them. I told them that the case had no merit, and I asked permission for my attorney and me to meet with Mrs. Vail's attorney to try to resolve the matter. They gave me their blessing.

". . . I went to the OR instrument room and reviewed all the instruments used for laparoscopy and hysterectomy - no blue caps. Nor could any of my colleagues recall any instrument with a blue cap used during such surgeries.

"On the day of the meeting, my attorney, knowing I had a Latin temper, instructed me to just listen, and not talk. When we arrived at the plaintiff's attorney's office, he began by summarizing the case for us. Apparently, Mrs. Vail had been having abdominal pain, and saw her doctor's physician assistant. He'd ordered a KUB, which revealed a "foreign body" in her abdomen. A few days later, she allegedly "passed" the mysterious blue cap from her vagina while on the toilet at home. The PA told her it had most likely been left in her abdomen at the time of her laparoscopy. That's when Mrs. Vail consulted the attorney.

"When the attorney showed us the blue cap, I realized that it had nothing to do with any medical instrument, or with my laparoscopy. It was a small rubber cap, about the size of a little fingertip. Then he showed us the KUB film. When I examined it, the "foreign body" appeared to be located in the colon - not the abdomen.

". . . I pointed out, when one does an abdominal hysterectomy, the vaginal cuff is closed, and it wouldn't be possible for a foreign body to pass through it once it's healed - especially not a decade later. Since the foreign body seen in the KUB had most likely been in the colon, it had probably passed out, not through Mrs. Vail's vagina, but through her rectum. Apparently, she had either swallowed the cap, or somehow inserted it herself in her rectum.

". . . I asked the attorney how in the world he could send me a letter threatening a lawsuit without first asking a physician consultant whether there was any merit in the allegation. I warned him that if he proceeded with a suit in this unfounded case, I would sue him for legal malpractice - and seek punitive damages. Finally, I told him that I wanted a letter from him saying that he wouldn't pursue the case, plus a written apology."

". . . Looking back now, I remember Mrs. Vail's attorney telling me during our meeting that this was the first time a doctor had ever come in to personally contest a claim after receiving a 60-day demand notice.

". . . I would encourage other doctors who receive a notice demanding immediate payment under the threat of a malpractice suit to do what I did. If you feel strongly that the allegations against you have no basis, call your insurance carrier and ask for permission to talk to the plaintiff's attorney - with your own attorney - during the 60-day window. It may save you the time, the expense, and the trauma of a lawsuit." To read the entire article, go to http://www.memag.com/memag/article/articleDetail.jsp?id=134991.

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7.    Overheard in the Medical Staff Lounge - Don't Follow Your Attorney's Advice

Dr Edward recalled that years ago he had received a letter from an attorney stating that he was about to be sued for malpractice. He called his medical liability carrier and his own attorney. He was told not to speak with his patient or the patient's attorney. He felt that he had good rapport with the patient and called him anyway and asked him what was the problem. The patient said that he wanted a copy of his operative report and that Dr Edward's office had refused to give him a copy. Against his attorney's and the medical liability insurance carrier's advice, Dr Edward told the patient to come by the office, met with the patient personally, went through the operative report explaining every detail and gave him a copy of his operative report.

The patient said thank you and left. He never heard from the patient, the patient's attorney, or the medical liability carrier again. Dr Edward feels certain that if he had followed his attorney's advice, there would have been an unnecessary lawsuit over a simple misunderstanding that would have been blown totally out of proportion by the attorney's involved.

In law, both the attorneys for the winners and the attorneys for the losers get their full fee. In medical legal cases, the physician always loses–even if he wins the verdict. Although the physician wins in the vast majority of the cases, in general his practice, marriage, family, house, and assets never fully recover.

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8.    MedicalTuesday Supports These Efforts of the Medical and Professional Community in Restoring Accountability in Medical Practice, HealthCare and Government

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Stay Tuned to the MedicalTuesday.Network and Have Your Friends Do the Same

The MedicalTuesday site has now been automated. Each individual on our mailing list and those that have been forwarded to us are now able to invite, register, or de-enroll as desired. You may want to copy this message to your Template file so that they are available to be forwarded or reformatted as new when the occasion arises. Then, save the message to a folder in your Inbox labeled MedicalTuesday. 

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Del Meyer

Del Meyer, MD, CEO & Founder



6620 Coyle Avenue, Ste 122, Carmichael, CA 95608

Words of Wisdom

P. J. O'Rourke: Giving money and power to government is like giving whiskey and car keys to teenage boys.

Winston Churchill: The inherent vice of capitalism is the unequal sharing of the blessings. The inherent blessing of socialism is the equal sharing of misery.

Thomas Jefferson: A government big enough to give you everything you want, is strong enough to take everything you have.

Review some recent postings below.

Voices of Medicine: To read a review of the first issue of Sacramento Medicine in 1950, go to http://www.ssvms.org/articles/0403vom.asp remembering that the first 132 years are no longer available. To read this year’s series of my column, the "Voices of Medicine," go to http://healthcarecom.net/vom2005.htm.

Charles B Clark, MD: A Piece of the Pie: What are we going to tell those bright-eyed little boys and girls who are going to be the doctors of tomorrow? When there isn’t anything left for them, are we going to tell them we didn’t fight because the changes were inevitable anyway? What are we going to say when they ask us why we laid down and died when things got a little tough? Are we going to feel good about ourselves when we tell them it’s all right because we got a piece of the pie? To read Dr Clark’s articles, click on his name at http://www.healthcarecom.net/OpEd.htm.

Ada P Kahn, PhD: Foreword to "Encyclopedia of Work-Related Injuries, Illnesses and Health Issues. Dr Kahn came to Sacramento in February and I joined her on a Channel 31 interview about her book. I was privileged to write the foreword, which we’ve posted at http://www.delmeyer.net/MedInfo2004.htm. To purchase the book, go to http://www.factsonfile.com/ and type in KAHN under search.

Henry Chang, MD: WEIGHT LOST FOREVER _ The Five-Second Guide to Permanent Weight Loss suggests daily weights to stem the weight loss before it becomes a problem and, if it does, how to take it off and keep it off. Congratulations to Dr Chang for winning the Sacramento Publishers and Authors 2004 award for "Best Health Book of the Year." Read our review at http://www.healthcarecom.net/bkrev_WeightLostForever.htm.

Tammy Bruce: The Death of Right and Wrong (Understanding the difference between the right and the left on our culture and values.) http://www.townhall.com/bookclub/bruce.html. Reviewed by Courtney Rosenbladt

An Alzheimer's Story: To read a touching story by a nurse about her Alzheimer's patient, go to http://www.delmeyer.net/MedInfo2003.htm.

An Entrepreneur's Story: AriadneCapital (http://www.AriadneCapital.com) provided the initial funding for MedicalTuesday and the Global Trademarketing. Julie Meyer, the CEO, has a clear vision in her mind of the world that she wants to live in, and it's considerably different from how it looks now. If you're an entrepreneurial woman, or if you lost hope or are having difficulty envisioning success, (if you'll forgive a little nepotism), the following article may be of interest to you. http://observer.guardian.co.uk/business/story/0,6903,1237363,00.html

On This Date in History - April 26

On this date in 1986, the World’s Worst Nuclear Disaster occurred in Chernobyl, USSR.

On this date in 1992, the Russian Orthodox Easter was celebrated for the first time in seventy-four years in Moscow, Russia.

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