Medical Tuesday Blog

Help For Physicians To Do Healthcare Correctly?

May 22

Written by: Del Meyer
05/22/2017 3:52 AM 

Dr. Steven Landers, MPH wrote:

Dear Del,

Healthcare reform is shifting the industry away from a fee-for-service model to paying for outcomes through value-based purchasing metrics as well as ACOs, risk-sharing models, shared savings programs, and bundled payments. This calls for a total overhaul in the structure of your business, and as a fellow business leader, I understand how frightening that can be.

But this is your chance to be a part of the conversation. At DecisionHealth’s 2014 Healthcare Transformation Leadership Summit, you’ll meet leaders on the forefront of these new delivery models who will share how they are meeting regulatory requirements, structuring process design and sustaining reimbursements.

As the head of VNA Health Group, the largest not-for-profit visiting nurse association in New Jersey, I’ll be there to talk about the role of home health in accountable care and bundled payment programs, as well as how technology can connect providers, payers and patients to ensure effective care plan oversight.

Come be a part of the transformation in healthcare and together we’ll make sure our collective voices are heard. Register at

I hope to see you in Las Vegas on Nov. 17-18, 2014.


Dr. Steven Landers, MPH

President and CEO

Visiting Nurse Association Health Group


Dear Steve,

Thank you for your views on our health care problem.
The very idea that physicians need oversight by underlings is absolutely frightening.
Many best practice protocols even makes life saving measures that don’t fall inside the protocol as too risky to pursue. It is sometimes more appropriate to allow a patient in whom the next stage of his illness is to die to then allow nature and time take their course rather do some heroic lifesaving treatment that the protocol demands which would cause more suffering in the final stages of life.
And conversely paying for outcomes designed by non-physician bureaucrats, even if followed by medical specialists, may not be in either the patient’s best interest or in a cost effective healthcare interest.
Recently a 90-year-old male I’d been seeing for 20+ years came with his arms wrapped up having had shunts inserted surgically for treatment of his kidney failure with hemodialysis while on vacation. He hadn’t understood that he would be lying in a hemodialysis center three half days a week.

We reviewed his chart concerning his long standing kidney function. On pointing out that his kidneys had reduced function for about 15 years as is common in a 90-year-old man. We then pointed out that had I sent him to a kidney specialist 10 years ago, they would have recommended dialysis. His family would have insisted that it be done immediately without the agreement of his personal physician. I could not have changed that course without being an ogre.  Hence, in view of his age and being a free spirit, I elected to manage his mild kidney failure medically. I pointed out to him that he also had mild respiratory failure (his P02 was 90) as we had discussed before but with the activity of a person in the tenth decade of life, he did not have significant breathlessness for the activities of his age. He did not require oxygen and less likely than not would he require oxygen treatment in the foreseeable future. He had also had a mild degree of congestive heart failure, but this could still be managed with the usual diuretics and with the usual activities of his age he did not suffer from breathlessness. Hence he had multi-organ failure for the past decade. He was grateful that I had not followed the usual protocols and he immediately reduced his dialysis days to twice a week. He told his daughters not to agree with anything any consultant recommended in the future without checking with his personal physician whom he had grown to trust over the past 20 years. He was doing well when I last saw him three months later.

Physicians since the time of Hippocrates have always served the patient first. They shouldn’t have to worry about meeting regulatory requirements, and structure their treatment process designed to sustain reimbursements rather than helping those we serve. This has caused our profession to lose its prestige and sense of excellence as every bureaucrat and other medical illiterates want to help us out.  They can only hurt the health care system, the patients, their doctors and nurses by their meddling.

Have you tried to socialize Legal-Care? Why should those that have been unfairly targeted by an Attorney have to spend several years of our income defending ourselves? Shouldn’t this suffering be spread out across our society? Wouldn’t that be fairer? Keep me posted concerning this more worthwhile effort.  Thank you for your letter.

Please give Ann my best. Was she your mother? I always admired her advice. But she never got the toilet paper procedure correct. Of course, Dr. Brizendine had not done her research of the Female Brain at that time, either.

Warmest personal regards,

Del Meyer, MD   

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