Physicians, Business, Professional and Information Technology Communities

 Networking to Restore Accountability in HealthCare & Medical Practice

 Tuesday, November 12, 2002

Important Message for Purchasers of HealthCare: Involve The Patient
The Mercatus (Marketing) Center at George Mason University is pleased to announce that their Professor of Economics and Law, Dr Vernon Smith, was honored with the Nobel Prize in Economics. He was cited for his pioneering work illustrating that some markets can work more efficiently if buyers and sellers have less rather than more information about each other’s strategies and preferences, thereby perfecting the game theory work done by Nobel laureate John F Nash, who was the subject of a recent movie, “A Beautiful Mind.” “What we found,” Smith explained to the press, “is that people don’t have to know anything but their own needs and circumstances for markets to work efficiently.” This would seem to hold a very important message for health care where many advocates of both “managed care” as well as “single-payer medicine” maintain that the patients are unable to know their needs and thus cannot be involved in the purchase of their own health care.

Federal Cops Forcibly Acquire Private Previously Confidential Medical Records
California rose to the top of the health care news this past week when it was disclosed that a cardiologist and cardiovascular surgeon in Redding along with their primary hospital was raided by 40 armed Federal Bureau of Investigation (FBI) officers, for the purpose of acquiring their medical records. The Medical Board of California (MBC) and State Attorney General officers weren’t far behind. News reports indicated that this Redding Medical Center had the largest utilization of cardiac catheterizations and coronary artery bypass graft (CABG) operations of any hospital outside of Southern California. They also had the highest rate of “medicare outliers” (requested reimbursement costs exceeding guidelines). Although the court hearing is set for today and their practices may be history by the time I click my mouse, it may take years for the dust to settle. However, some observations on how this occurred and could have been avoided in a competitive free Medical MarketPlace are in order.

Entitlements Are Never Utilized Equally–They Invite Excesses
Why was it possible for a cardiologist and surgeon to rack up such large volumes of cases that they could annually earn nearly (or exceeding) a million dollars? Many Americans feel that making more money from tax dollars than even the most powerful man in the world who occupies the White House earns, should be illegal. If the physicians had developed their volume in a free market rather than an entitlement program, it would be a different matter. Firstly, they would be held accountable for their actions every time a patient wrote them a check. For example, if the patient had to pay 20% of the cardiologist' and surgeon's fee, as Medicare was initially designed to do before the days of Medigap insurance (which effectively removed Medicare from the Medical MarketPlace), the patient would police his own care and expect satisfaction. Just the simple courtesy of patients returning to their personal physician to discuss the cardiologist's findings would have stopped the stampede from the cardiac cath lab to the operating theater. In a small community like Redding, California, any patient dissatisfaction would spread like wildfire through the town, and the doctors would be without patients; hence the problem could never have reached such magnitude. Secondly, if patients had to write a check, even if for only 10% of the hospital bill, they would have a vested interest in the quality of care from the hospital. By comparing the Redding Medical Center with the Mercy Hospital in the same city, they would have found vastly different statistics which could have given them pause for careful consideration. Had they become aware of the unexplainable volume disparity, they would have sought their care with caution. The news reports included a story concerning a priest who did just that. He took his records to a cardiac team in Nevada to have his CABG. When they looked at his coronary arteriogram, the cardiologist told him that he had normal coronaries and thus no CABG operation was necessary. Thus, when your life is at stake, people will travel to obtain care elsewhere, just like Canadians travel across the border to acquire a higher level of care in the United States.

Consultations ARE a Second Medical Opinion
The news reports also mentioned that the Redding situation gave new impetus for a second opinion which should be authorized by and, therefore, paid by the patient's Medicare, HMO or other insurance carrier. However, that would not solve the issues. The news reports indicated that the patients were referred by their personal physician, with whom they should have discussed the consultative cardiology findings and recommendations before proceeding with an operation. Furthermore, the news reports indicated that some of the patients admitted that their pulmonologist recommended against the surgery, yet they still had it done. Hence a fourth or fifth “second opinion” would not have made much difference.

Medicare Entitlements Allow Whatever the Traffic Will Bear
Medicare and other third-party payments allow health care providers (hospitals, surgicenters, pulmonary rehab units, or physicians and surgeons who are in the business of medicine rather than the practice of medicine) to utilize the system disproportionately in order to bring in excessive revenue (See MedicalTuesday, Oct 29, paragraph 8, MedicalTuesday’s Mission). These loop holes for unlimited access to the US Treasury are seldom closed until the FBI or MBC police arrive with guns drawn. This illustrates the impersonal nature of government Medicare. In the competitive Medical MarketPlace, the resolution would have come sooner, without guns, in a civilized, humane manner, with the end result being less devastating to the patients.

Is There a Market Force in Patient’s Sexual Practice?
When I had completed my medical interview and physical examination with a new patient recently, I began discussing my recommendations, completing a laboratory requisition, and writing the appropriate prescriptions. I asked the patient if he needed anything else. He said he would also like a prescription for 15 Viagra tablets with monthly refills. As I was writing this script, I must have raised my eyebrow, for he told me this story. “My wife died two years ago after fighting cancer for five years. During that time, we were unable to enjoy many marital pleasures. This past year, I found a very lovely woman who lost her husband to cancer a year earlier. We recently got married and I feel young again. She’s given me pleasures I have never experienced before. One morning after I got out of the shower, she said ‘John, I think that Viagra you took last night that worked so beautifully is still working. You know, we shouldn’t waste it. I think you should come back to bed and make love to me.’ You know doctor, since that time I found that if I took a Viagra every other night, I could make my wife happy again the following morning. Living on a pension, paying for a $9 pill daily, starts to add up. Since we found that 15 pills ($135) could do the job of 30 pills ($270), it certainly makes my pension go further. And it also makes my retirement much more enjoyable."

Medical Decisions Should Be in the Private Medical MarketPlace
Not only did I think that was a beautiful story, I thought it epitomized the Medical MarketPlace. Would there be any incentive for this patient to cut medical costs in half if Viagra were a benefit of Medicare, or HealthNet or Blue Cross where prescription information is recorded in their computers and made available to the industry? Or, if doctors had to write medical justification, the intrusion would not only be ludicrous, it would be dehumanizing. Such matters should rest between the patient and his physician.

National HealthCare Systems in the English-speaking World (No 6)
John C Goodman, PhD, president of the National Center for Policy Analysis (www.ncpa.org), in his recent update of the “Twenty Myths about National Health Insurance,” states that the failures of national health insurance are one of the great secrets of modern social science. Not only do ordinary citizens lack an understanding of the defects of national health insurance, all too often they have an idealized view of socialized medicine. For that reason, Goodman and his associates have chosen to present their information in the form of a rebuttal to commonly held myths.

Myth Six: Countries with Single-payer Health Care Systems Maintain a High Quality of Health Care
Goodman states that proponents of a single-payer health care system for the United States maintain it would “provide access to high quality care for everyone at an affordable price.” However, he maintains, if the experiences of countries that already have a national health insurance are used as a guide, there is no reason to believe that claim. As we saw under Myth Five, (MedicalTuesday October 15), in countries where the government controls health care resources, advanced, high quality treatment for many serious conditions is simply not available to all patients. In regards to cancer mortality, less than one in five patients with prostate cancer die of their disease in the US, while in France and Germany more than two in five and in the UK nearly three in five die of the cancer. Goodman and his associates recite numerous incidences in both the Canadian and UK press which is teaming with reports of harm to patients caused by inadequate quality of care, such as rampant hospital-acquired infections, inadequate access to care such as donated lungs which arrive in a hospital where no ICU beds are available so the recipient could not be admitted and the organs were wasted while 30 other patients continue on the waiting list, or long-term care patients blocking acute care beds due to a shortage of long-term beds. Five times as many patients in England and Wales died from receiving the wrong medicine in 2000 than a decade earlier. Americans really don’t want these additional problems of single-payer medicine.

When governments bypass the market process, curiously, the market is still found–illegally
An investigation by Belgian customs authorities found that at least three million doses of the drug Combivir–earmarked for sale in Africa at about $0.78 per dose–have found their way onto European pharmacists' shelves, where they sell for about $5.94 per dose.

Patmos EmergiClinic - www.emergiclinic.com
This week we feature the Patmos EmergiClinic, where Dr Robert Berry, MD, an emergency physician,  provides prompt care for many of the injuries and illnesses treated in Emergency Rooms at a fraction of their cost. As a board certified internist, he also takes care of chronic problems such as diabetes and hypertension. Since opening in January 2001, PATMOS has accumulated over 3000 patient charts. PATMOS literally stands for "Payment At TiMe Of Service." Patmos was the island to which political prisoners of Rome were exiled during Biblical times. As a little play on words, PATMOS was established to care primarily for the politically exiled within our healthcare system - the uninsured. PATMOS Emergiclinic makes no apologies for not accepting insurance. Dr Berry states on his website: In order to keep costs down for those who have no other choice, we cannot assume the massive overhead involved in billing third party payers. This has the added benefit of eliminating bureaucratic hassles and intrusions into the doctor-patient relationship as well as insuring strict confidentiality of patient information. Besides, our typical charges are usually less than those of most local veterinarians. Congratulations to Dr Berry for making comprehensive primary medical care more affordable and spearheading a new movement toward patient-driven healthcare.

MedicalTuesday Recommends the Following for Their Efforts in Restoring Accountability
The Greg Scandlen Health Policy Comments is an important source of market-based medicine. You may log onto NCPA (www.ncpa.org) and register to received Greg’s weekly report, or the weekly Health Policy Digest or the full NCPA daily report. We also recommend the market-based reports of Lew Rockwell, president of the Ludwig von Mises institute. Please log on at www.mises.org to obtain the foundation’s reports or log onto Lew’s premier free market site at www.lewrockwell.com. Martin Masse, director of the Montreal Economic Institute, is the publisher of the webzine: Le Québécois Libre. His enlightening articles can be found at www.quebecoislibre.org/apmasse.htm. The Mercatus Center at George Mason University is a strong advocate for accountability in government. You may register your email address or read their government accountability reports at www.mercatus.org.

MedicalTuesday Recognizes the Following Efforts in Restoring the Doctor & Patient Interface: Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP) www.sepp.net, for his 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; SimpleCare for their success in restoring private practice, www.simplecare.com; HealIndiana as a supporter of market-based medicine, www.HealIndiana.org;  the AAPS representing physicians in their struggles against bureaucratic medicine www.AAPSOnline.org. The AAPS was instrumental in the defeat of the Canadian-style socialized medicine initiative in Oregon that lost  by a 4 to1 margin last week, by running 200 radio spots in 12 cities across the state, holding news conferences, sending mailings and email alerts, and doing radio interviews. Oregon voters refused to be Guinea Pigs when there are enough Guinea Pigs around the world already.

Welcome to the UCD MBA Students
This week we welcome the MBA students at the University of California, Davis who put on a “Big Bang” seminar last Wednesday. It included Start Up Entrepreneurs and Venture Capitalists who gave presentations to the graduate school. Invitees included the MBA and MIS graduate students from California State University, Sacramento, and interested community startups such as MedicalTuesday and HealthPlanUSA. The MBA (Masters in Business Administration) & MIS (Masters in Information Services) students who had applied for an internship with MedicalTuesday and HPUSA made many important contacts.

Stay Tuned to the MedicalTuesday.Network
Each individual on our mailing list is personally known, requested to be placed on our mailing list, or was recommended as someone interested in our cause of making HealthCare affordable and accountable. If this is correct, you may consider opening a folder in your inbox labeled MedicalTuesday or copying this message to your template file so that they are available to be forwarded or reformatted as new when the occasion arises. We invite your response, the re-sending of this to your friends and colleagues and other interested business and professional associates. If this is not correct or you are not interested in or sympathetic to a  Private Personal HealthCare system, email DelMeyer@MedicalTuesday.net and your name will be sorrowfully removed.

Del Meyer, MD, CEO & Founder