Physicians, Business, Professional and Information Technology Communities

 Networking to Restore Accountability in HealthCare & Medical Practice

 Tuesday, February 11, 2003

For the Advancement of Science
The Association of American Physicians and Surgeons (AAPS)  met in San Antonio on February 1, 2003, to discuss regulatory intrusion of medicine practices which destroys patient privacy and lowers the level of patient care. After finding a seat at the 8 AM meeting, I booted up my laptop, connected my Nextel and downloaded my email. The first message was a news alert timed 7:01 AM from WSJ concerning the Columbia disaster. Two of our physician colleagues along with other pioneers gave their lives to the cause of scientific achievement and advancement. Our sincere sympathy to the families of our heroes.

Remember the Alamo
We visited the Alamo where 183 heroes (according to historian Walter Lord, author of A Time To Stand–The Epic of The Alamo)  who defended Fort Alamo gave their lives on March 6, 1836, the thirteenth day of battle. The women and children huddled in the chapel were spared. Forty-six days later, April 21, 1836, Texas came roaring back. Chanting “Remember the Alamo,” they won their independence in an 18 minute battle. The  Republic of Texas was established and a decade later became the twenty-eighth state in the USA.

Altering the Course of History
Meanwhile, at the AAPS meeting, speaker after speaker testified to the intrusion, under the ruse of protecting confidentiality, of medical practice by government regulators,  insurance carriers (which have become health maintenance organizations) and hospital sham peer reviewers. As a result, our patient records have been made available to many organizations, some of which are only peripherally involved in the health care process and do not need confidential patient information. The federal government, in their efforts to micro-manage Medicare, has criminalized medical coding. Hence, our legal counsel outlined the status of physicians who have been or are being sent to prison for minor variations in their practice. For example, if one item of the examination wasn’t fully recorded, the evaluation and management code changes; this makes medical-legal criminals out of our profession. These unsung heroes have given their professional lives. Let’s hope that Congress and Medicare and the Courts will soon understand the problem and restore our freedom to help our patients.

MedicalTuesday Will Continue to Bring You Messages That Affect Your Practice
If you have received this message as a forward, please click on DelMeyer@MedicalTuesday.net and request your personal free subscription. Be sure to include your name, business or profession, and city/country with your email address. Please forward this message to any person you feel is or should be interested in providing patients with confidential, high quality personalized health care without the intrusion of the government. Government involvement will always compromise medical care, confidentiality and privacy.

British National Health Service (NHS) On the Brink of Implosion (From our UK Connection)
The Financial Times reported last week that, in a pamphlet to be published by the Centre for Policy Studies (www.cps.org.uk), that Dr Maurice Slevin, a leading cancer consultant at Barts and the London NHS Trust for the past 20 years, says “I still work in the NHS as a cancer physician. I have seen at first hand the steady decay of a great public institution.... The NHS is imploding.” His scathing report is backed by 15 fellow specialists. “Waste and mismanagement are rife,” and there is “little evidence” that the new investment of £40 billion of public spending over five years will make much difference. The pamphlet, Resuscitating the NHS: A Consultant’s View, concludes that the extra funds will produce results only if the way the money is spent is changed. He urges a dramatic reduction in the number of managers and administrators in the NHS and proposes a voucher system to enable patients to shop around for treatment in the public or private sector. He points out that the NHS has nearly as many health service managers, administrators and support staff as they have qualified nurses. A private hospital in London employs 240 nurses and has 43 management, administrative, and support staff–a ratio of one to six instead of one to one. The chief executive of the NHS retorted that over the last year the waiting list has decreased by 5 percent.

Why Would Americans Want a System of Health Care Where Years of Waiting Can Be Reduced by Only 5 Percent Instead of Eliminated?
Why are there proponents of a single payer system in our country who maintain that we want this British or Canadian system? I have personally never encountered significant waiting time for diagnostic testing, surgery, consultation, or hospitalization, for either a wealthy patient or one on welfare. Why would anyone want to exchange a system that delivers HealthCare for one that puts you on hold? Single payer proponents are interested in neither patients nor their HealthCare. They are only interested in gaining power and control, even if it means destroying freedom and hurting sick people.

Government Lack of Protecting Freedom Is a Twentieth Century Phenomenon and Applies to All Government Functions or Programs
When California passed Proposition 13 to reduce taxes and make schools and government leaner and more efficient, they mimicked the British. They actually fired teachers and hired more administrators–just the reverse of what the voting taxpayers wanted. The government was neither interested in our children nor their education–only in money and power, and in teaching the voters a lesson even if it meant hurting children and making them more illiterate.

National HealthCare Systems in the English-speaking World (No 11)
In his recent update of the “Twenty Myths about National Health Insurance,” John C Goodman, PhD, president of the National Center for Policy Analysis (www.ncpa.org), states that ordinary citizens lack an understanding of the defects of national health insurance and all too often have an idealized view of socialized medicine. For that reason, Goodman and his associates have chosen to present their information regarding commonly held myths in the form of rebuttal. See previous issues or the archives at www.MedicalTuesday.net for the summary of the first ten myths or go to www.ncpa.org for the original 21 chapters of the book.

Myth Eleven: Under Single-payer Health Systems, Health Care Dollars Would Be Allocated So That They Have the Greatest Impact on Health.

Of all the characteristics of foreign health care systems, the one that describes how limited resources are allocated among competing needs strike American observers as the most bizarre. Foreign governments do not merely deny lifesaving medical technology to patients under national insurance schemes. They also take millions of dollars that could be used to save lives and cure diseases and use it to provide services to people who are not seriously ill. Often, these services have little if anything to do with health care.

Spending Priorities in Britain
Goodman, et al, point out that throughout the British National Health Service (NHS), there is a tendency to divert funds from expensive care for the small number who are seriously ill toward the large number who seek relatively inexpensive services for minor ills. Take the British ambulance service, for example:
• English “patients” take between 18 and 19 million ambulance rides each year–about one ride for every three people in England.
• Almost 80 percent of these rides are for non-emergency purposes (such as taking an outpatient to a hospital or an elderly person to a local pharmacy) and amounts to what might be described as little more than free taxi service.
While as many as 25,000 people die each year from lack of the most advanced treatments for cancer, the NHS provides an array of comforts for the many chronically ill people who have less serious health problems. For example:
• The NHS provides nonmedical services to about 1.5 million people a year
• These include daycare services to more than 260,000, homecare or home help services to 578,000, home alterations for 375,000, and occupational therapy for 300,000.
While more than one million people wait to be admitted to NHS hospitals, the NHS wastes millions on time lost by general practitioners and outpatient departments because patients don’t show up for their appointments and don’t cancel:
• An estimated 10 million GP appointments totaling more than 2.5 million hours are missed each year.
• The Doctor Patient Partnership, a British health education group, has calculated that this represents the work done by an additional 1,692 doctors.
• Options to charge patients for missed appointments creating money to treat thousands of additional cancer patients each year are not seriously considered.

Spending Priorities in Canada, Australia, and New Zealand
Although not as pronounced, similar trends can be observed in Canada, Australia and New Zealand. Here the government has expanded the services of general practitioners while tightly controlling access to modern medical technology. All these countries also encourage the provision of routine services for the many mostly healthy people at the expense of specialized care for the few seriously ill. For example:
• In the US, only 11 percent of all physicians are engaged in general or family practice
• In Canada, just over half of all physicians are general practitioners
• In Australia, approximately two in three physicians are general practitioners
• In New Zealand, nearly half of all physicians are general practitioners
In general, Canadians have little trouble seeing a GP, but often wait as long as 28 weeks to see a specialist. While the US has seen a major expansion of outpatient surgery, Canada has actively discouraged this trend–presumably to control spending. CT scanners are generally restricted to hospitals.

Medical Gluttony (or Unnecessary Medical Care)
Last week I saw a 40-year-old patient, a graduate engineer, who has a mild degree of obstructive sleep apnea. He is obese but has no underlying lung disease. He does not qualify, according to guidelines, for a nocturnal Continuous Positive Airway Pressure (CPAP) breathing device. I noted that he is not working and is on Medicaid, the US health and welfare program for the indigent. Since he is able to work, I asked why he wasn’t. He stated he chose not to work so that he could develop an engineering program on his computer and go into business sometime in the future. If he took a job, he wouldn’t have the time to do this. Since he has no income, the state must give him both his welfare check and his Medicaid health benefits.

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The MedicalTuesday Recommends the Following in Restoring Accountability in Government and Society:

• The National Center for Policy Analysis, John C Goodman, PhD, President, issues a weekly Health Policy Digest which is a health summary of the full NCPA daily report. You may log on to NCPA (www.ncpa.org) and register to received one or more of these reports.

• The Mercatus Center at George Mason University is a strong advocate for accountability in government. Nobel Laureate Vernon L Smith, PhD, has recently joined its Economics faculty. This week we heard from Dr Paul Edwards, President, introducing J C Watts, as a Distinguished Visiting Scholar after eight years in Congress. He is a former star quarterback for the University of Oklahoma, a football dynasty. He joins Lawrence Kudlow, of Kudlow & Cramer on CNBC, a Distinguished Scholar, and Maurice McTigue, QSO, also a Distinguished Visiting Scholar, who was instrumental in revolutionizing the way government did business in New Zealand from 1984 to 1994. By looking at how effective every single government program was in achieving the required results, New Zealand went from having the most socialized and highly-regulated economy of any western-style democracy, to having the freest, reducing the cost of government from nearly half the GDP to slightly over a quarter of the GDP. He is optimistic about making the same progress in the US. The Mercatus Center recently published a pamphlet, “A Day in the Life of a Regulated American Family,” that documents the costs of $8,000 the average American family pays per year to meet government regulations. (So you thought July 4, Independence Day was the day you start working for yourself having paid your tax obligations? Well try Labor Day, The First Monday in September, as the day we begin laboring for ourselves having completed our financial servitude to the government.) Please log on at www.mercatus.org to read the government accountability reports and information on Dr Smith’s economic experiments which help us understand health care issues. You can also register to receive updates.

Martin Masse, director of the Montreal Economic Institute, is the publisher of the webzine: Le Québécois Libre. Please log on at www.quebecoislibre.org/apmasse.htm to review his free market-based articles, some will allow you to brush up on your French You may register to receive copies of his webzine on a regular basis.

• The Ludwig von Mises Institute, Lew Rockwell, President, is a rich source of free market materials, probably the best daily course in economics we’ve seen. If you read these essays on a daily basis, it would probably be equivalent to taking Economics 11 and 51 in college with considerably less bias. Please log on at www.mises.org to obtain the foundation’s daily reports. You may also log onto Lew’s premier free market site at  www.lewrockwell.com to read some of his lectures to medical groups such as how state medicine subsidizes illness.

Hillsdale College, the premier institution for producing graduates that understand Free Market accountability, which receives no federal subsidies placing them at a monetary disadvantage to all other colleges and universities, recognizing that the price of freedom is never cheap. You may log on to  (www.hillsdale.edu) to register and receive Imprimis, the national speech digest, that reaches over one million readers each month. Last month Imprimis  featured Charles Krauthammer, MD, a psychiatrist at Mass General prior to becoming a journalist in Washington, DC, who also serves on President Bush’s Council on Bioethics.

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MedicalTuesday Supports These Efforts in Restoring the Doctor & Patient Relationship:

PATMOS EmergiClinic - www.emergiclinic.com where Robert Berry, MD, an emergency physician and internist, provides prompt care for many of the injuries and illnesses treated in Emergency Rooms at a fraction of their cost as well as an internal medicine practice;

Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP) www.sepp.net for making efforts in Protecting, Preserving, and Promoting, the Rights, Freedoms, and Responsibilities of Patients and Health Care Professionals, with a special page for our colleagues in nursing;

Drs David MacDonald and Vern Cherewatenko for their success in restoring private based medical practice which has grown internationally through their SimpleCare model network, www.simplecare.com; Dr MacDonald presented their plan in San Antonio on Saturday, February 1, 2003. Dr Dave has also partnered with Ron Kirkpatrick to start the Liberty Health Group (www.LibertyHealthGroup.com) to assist physicians by helping them to control their medical benefit costs for their staff and patients. He says, “More importantly, we educate and empower their employees and patients regarding the benefits of payment at the time of service.” He is available to speak to your group on a consultative basis. You may contact him at DrDavid@LibertyHealthGroup.com.

The Association of American Physicians & Surgeons, (www.AAPSonline.org) The Voice for Private Physicians Since 1943,  representing physicians in their struggles against bureaucratic medicine and loss of medical privacy. The AAPS midyear one day conference, Thrive–Not Just Survive II, last Saturday, February 1, 2003, in San Antonio was a repeat sold out success. The voluminous resource book exceeded that of most three-five day conferences. Topics included Opting out of Medicare; How to set up a cash practice with SimpleCare; Billing, Coding, Compliance & Pitfalls; Save on HIPAA Compliance; Prepare for and avoid fraud prosecutions and audits and how make your practice judgment proof; Surviving sham peer review and licensing hoops. Thanks to Kathryn Serkes, our liaison in Washington, DC, for compiling these resources.

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Stay Tuned to the MedicalTuesday.network and Have Your Friends Do the Same
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Del Meyer

Del Meyer, MD, CEO & Founder