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Increasingly Strained Relationship Between Jackson Health System and the University of Miami Print E-mail
Written by Bernd Wollschlaeger, MD   
Wednesday, 07 December 2011 12:44

IN MY OWN WORDS

An interesting Miami Herald article by John Dorschner titled "Finances strain the marriage between Jackson and the University of Miami" details the increasingly strained relationship between Jackson Memorial Hospital and the University of Miami. At the center of the dispute are insured patients seeking medical care at Jackson Memorial hospital. UM critics claim that UM physician direct these patients to the UM hospital across the street, and that Jackson Memorial hospital is left with treating the uninsured patients.

Miami-Dade taxpayers pay Jackson Memorial $330 million a year to treat uninsured people who seek treatment in the county-owned Jackson system. As part of the system that has evolved over the years, Jackson also pays UM when its doctors treat the uninsured at Jackson. UM critics also claim that once an uninsured patient gets insurance UM doctors are shifting their care to the UM hospital, which then receives the Medicare reimbursement money. UM calls that patient choice. Jackson counters that its paying patients shouldn't be siphoned off to UM facilities.

What troubles me is that patients are being considered as milkable cash cows and once they lose their production value they are being pushed back into Jackson Memorial Hospital. It's a sick system which encourages overutilization of medical services and drives up healthcare costs even further.

Last Updated on Tuesday, 27 December 2011 20:19
 
Personhood Amendment: Unnecessary Government Intrusion in the Physician-Patient Relationship Print E-mail
Written by Bernd Wollschlaeger, M.D.   
Wednesday, 16 November 2011 12:16

IN MY OPINION


On November 8th Mississippi voters will be asked to decide on a proposed amendment to the state constitution, which would define as a person "every human being from the moment of fertilization, cloning, or the functional equivalent thereof." For most voters it sounds like a good idea and it will most probably pass. Therefore, several other states, including Florida http://personhoodfl.com/, are preparing similar constitutional amendments. Florida Senate Majority Leader and former US Senate Candidate Mike Haridopolos recently signed the FL Personhood Amendment!! The ambiguous language in the Florida and Mississippi 'personhood' amendment are intentionally not being represented properly by the proponents of this ballot initiative.

A recent New York Times article correctly points out the following problems:

"First, what does "fertilization" mean? As embryologists recognize, fertilization is a process, a continuum, rather than a fixed point. The term "fertilization" - which is sometimes considered synonymous with "conception" - could mean at least four different things: penetration of the egg by a sperm, assembly of the new embryonic genome, successful activation of that genome, and implantation of the embryo in the uterus. The first occurs immediately; the last occurs approximately two weeks after insemination (or, in the case of embryos created through in vitro fertilization that do not get implanted, never). Thus, on some reasonable readings of the amendment, certain forms of birth control, stem cell derivation and the destruction of embryos created through in vitro fertilization would seem impermissible, while on other equally reasonable readings they are not."
 

Following the "logic" of the "personhood" advocates, doctors can be charged with manslaughter or even murder by prescribing morning after pills, because it can irritate the lining of the uterus (endometrium) so as to inhibit implantation of a fertilized egg, i.e. "killing a person."  A doctor could also be criminally charged by inserting an IUD because it adversely affects a new embryo as it enters the uterus, thus preventing it from implanting in the uterine lining. Again, according to the "personhood" advocates this constitutes the "killing of a person."Even though, abortions are still being protected by federal law women may still face criminal charges according to state law. 
 
Other unintended consequences include the question if the treatment of an ectopic or a molar pregnancy requires first a court order to overrule a "personhood" amendment in the respective state constitution.  Obviously any delay of these time sensitive treatment decisions may harm the mother and even jeopardize the life and well-being of a woman.

I urge all of you to speak up against any such ballot initiatives, to protect the physician-patient relationship and to guard against further state intrusion into our lives.

Last Updated on Wednesday, 30 November 2011 17:42
 
Pill Mill Update Print E-mail
Written by Jeffrey Herschler   
Thursday, 03 November 2011 09:14

A quick scan of the headlines reveals mostly positive news on the illegal pharmaceuticals front.

Pill Mill Busts from Around the State

However, there are some unintended negative consequences to the Florida clean-up. See Florida's Pill Mill Crackdown Leads to Crime Elsewhere.

Meanwhile Tara Pihn's contribution, I Read the News Today Oh, Boy went viral.

·         Web Visits to FloridaHealthIndustry.com up 48.4%

·         Story picked up by Health News Florida

·         Story read globally; Read in US, UK, Belgium, France, Thailand, India, Canada, Sweden and Switzerland

·         The story was #1 in organic, Google search (Pill Mill + Alt Weeklies) the week of Oct 10th

·         Two related video posts (posted by FHItv on You Tube) scored #3 and #13 respectively while the Health New Florida post garnered a #21 in an organic Google  search October 11

There is increasing evidence that Pain Management Clinics are complying with, at least, the letter of the law.    A review of advertisements and websites reveals that most are insisting on Florida State I.D.s from new patients.  Most clinics have minimum age requirements and some even have Mission Statements posted to their sites.  One clinic boasts that it contracts "a premier health care attorney, and a State of Florida Licensed Risk Manager to support and facilitate ongoing compliance."

Don't crack the bubbly yet.  A quick check of the Pill Mill Barometer (the back pages of Broward/Palm Beach New Times) reveals 36 ads for pain management related services.  This is the same count Tara got when she originally posted her story in late September.   And even more ominously, there is a new advertiser with this headline:  TIRED OF FLORIDA HASSLES.  The new sponsor is located in Tucker, GA.

Last Updated on Thursday, 03 November 2011 09:28
 
HCA medical center plans trauma center against judge's ruling Print E-mail
Written by Michael Newhouse   
Thursday, 27 October 2011 09:58

READER RESONSE

As a fiscal conservative and health care executive, sometimes I am at odds with both hats. But when it comes to the question of adding trauma centers I have firsthand experience, and the State of Florida has some very strong data against the addition of most trauma centers. Plus, their process (last I looked) seemed pretty fair. These are highly specialized centers requiring specially trained personnel with exceptional skills that are not forged in the classroom. It takes years of sleepless nights working in a trauma center to develop the temperament and necessary skills to become an effective trauma center team.

My conservative side would say that let the market determine the outcome. I love that line-don't you? It sounds so fair and as American as apple pie. In most cases, I believe that it is true for most if not all commodities. The one big exception is health care because the public ultimately ends up picking up the cost of failure in terms of dollars and lives. Still, I may even argue this is part of natural selection.  Well, if natural selection would not be influenced by the highly paid lobbyist of HCA then sure.  But who does not believe these lobbyists have not already been involved and already have several votes in their hip pocket?

Well, then what do we do about this question? If you ask me first we should treat such things as trauma centers much like we treat public utilities, and put it up for bid. Also, it's all or nothing, i.e. either do a full trauma center or nothing. Then let's see if they have belly for the investment. Please don't cherry pick at the cost of the taxpayer. We can no longer do business as usual. So, sorry HCA.  Stop making a major portion of your profits in Florida, and then taking the money off shore at further expense to our tax payers. Have a little patriotism---haven't you been watching the protest on Wall Street? It's funny how the real issues are always relegated to the back page.

-Michael Newhouse, Healthcare Executive, Miami-Dade

 
Reader Response October 2011 Print E-mail
Written by Various Readers   
Friday, 21 October 2011 09:33

RE:  The Legality of Online Health Care Discounts

Attached you will find a link to an interesting article titled "Are Groupon discounts for medical treatments illegal?" highlighting an important issue: Those big discounts on health care treatments offered on websites like Groupon may be illegal, medical law experts say. Not for the patients but for the medical professionals giving them.

"The law is very strict. This seems like a problem," said Michael Segal, a South Florida health-care lawyer. "I would urge [practitioners] to be very careful. You don't want to find out there's a concern after you have done it."

A number of national and local medical associations, including the Palm Beach County Medical Society last month, have warned members because the issue is still in doubt. Florida regulators said they have not discussed it. Medicare has taken no position. Nor has the American Medical Association or other medical trade groups. 

 -Bernd Wollschlaeger, MD, Miami           

See related article:
Groupon and Other Daily Deal Sites: Old Regs, New Problems


RE:  Governments and Markets

Bill Clinton had an interesting comment recently.  "All the successful economies have public/private cooperation to generate economic opportunity, provide a good education, create an environment where government and the private sector work together and advance economies" he was quoted as saying on CNN.com (How to Fix the Economy, Oct. 7).  Mr. Obama and his team don't appear to appreciate the concept of partnership between government and the firms that operate in the free marketplace.  It's not as if the government doesn't mean well.   Everyone abhors pre-existing condition clauses and it is virtually unanimous that health plans ought to cover basic preventative care and ought to eliminate policy limits.   But are these ideas feasible in the marketplace?  Supply and demand determine price.  These forces are innate.  And just as the government can't order a hurricane to veer right and avoid a direct hit on Florida, it also can't dictate to the market.  

-Healthcare Economist, College Park, MD
 
Last Updated on Friday, 21 October 2011 09:42
 
Readers weigh in on entitlements, whistleblowers Print E-mail
Written by Various Readers   
Thursday, 13 October 2011 09:41

READER RESPONSE

RE:  Unsustainable Entitlements

A South American friend detailed the health system and health policy in her home country.  Fact is there isn't much of a policy, a system or a plan.   This is a developing nation that embraces democracy and capitalism and is similar to the U.S. pre WW II.  The small segment of the affluent professionals has a health plan through work.  And of course the very rich just pay cash. But middle class and lower don't have a plan.  They hope and pray they won't get sick.   They may eat well, exercise, quit smoking and drink in moderation.  Or they might not.  If they get sick, they go to a doctor and pay cash for the treatment and the prescription.  They rarely go to a physician for preventive care. Disabled people and the aged are taken care of by family.  If you don't have family or your family is poor, you rely on charity.  If you have a serious medical issue, you rely on charity.  A lot of people die because the charitable pesos can only go so far. 

 My friend told me her father had died years ago.  How old was he?  Late 60's.  Why did he die?  He was old, he got sick and he died.He was seen by a PCP but no specialists cared for him.  There were no lab tests.  No diagnostic imaging was performed.  There was no diagnosis.  "Maybe it was a cancer" my friend said.  The mother died recently.  Similar story, except she was in her 70's.  She got sick, she stopped eating, and she spent a lot of time in bed.  Eventually she died. At home.  She was seen by a PCP but no specialists were called in and no tests were done.  There was no explanation for her death except the obvious:  She was old, she got sick and she died. 
In my friend's country, they spend 7.3% of GDP on healthcare.  In the U.S. it's 16%.   Please view this link which displays health care costs as a percentage of GDP in various countries.  My friend's country does a much better job of allocating scarce resources and these efficiencies deliver healthcare at less than half the cost of the U.S.  There are no overutilization issues.  There is no national debate on fraud or reform.  Free markets are efficient, government programs are not.  But free markets can be cruel.  In the U.S., the Progressives choose the high road by building a healthcare system mired in red tape, inefficiency and high costs.  Thus, a system was conceived and implemented that is bit more fair and bit less cruel.   A very, very expensive scheme that is humane and civilized. 

We face a crossroads here.  Can we elevate our health system so it can be both humane and affordable?     

-Healthcare Executive, Broward

 

RE:  Whistleblowers

I enjoyed Tara Pihn's recent article on the subject and wanted to share this link:
Blowing the Whistle Can Net You Big Bucks
9.21.11 - Daily Finance               

 -Healthcare Marketing Consultant, Gainesville
Last Updated on Friday, 21 October 2011 09:43
 
Hospital Status Quo Battles HCA Print E-mail
Written by Jeffrey Herschler   
Thursday, 13 October 2011 09:39

This headline ran in the late Sept issue of FHIweekly:

Judge Rules Against Trauma Centers
9.27.11 - News Service of Florida via ClayToday.biz

See also:

HCA medical center plans trauma center against judge's ruling
9.29.11 -Fierce Healthcare

This dispute pits HCA against some prominent hospitals in the Tampa and Jacksonville areas (Bayfront Medical Center, Tampa General, St. Joseph's and Shands).  In the article, one hospital spokesman complained the proposed new centers would result in a "...loss of approximately 1,000 patients annually, or 25 percent of... current trauma volume.''

Meanwhile, HCA argues that Jacksonville and Tampa Bay hospitals are attempting to "monopolize the delivery of trauma services through restraint of trade or commerce."

Please weigh in on this issue by submitting a READER RESONSE.

Last Updated on Thursday, 13 October 2011 09:56
 
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