Former Tufts doc and current Mainer Howard A.Corwin comments this weekend on the latest in Elizabeth’s Rosenthal’s great NYTimes series on insane health care costs. In her latest piece, she reports that “In operating rooms and on hospital wards across the country, physicians and other health providers typically help one another in patient care. But in an increasingly common practice that some medical experts call drive-by doctoring, assistants, consultants and other hospital employees are charging patients or their insurers hefty fees.”
To the Editor:
Doctors call such billing “gaming the system.” There is widespread dishonesty that leads to these unjustified expenses throughout the medical profession. Members of Congress beholden to medical lobbyists allow flawed reimbursement systems and perpetuate them by preventing reform. There is an enormous disparity between what different medical specialists and personnel earn. Unable to rectify these disparities, many physicians resort to these gaming techniques. Unnecessary expensive tests and procedures, upgraded coding, “scratch my back and I’ll scratch yours” referrals and, of course, outright greed lead to extra medical expense.
Honest doctors are demoralized and suffer from this system. Doctors must regain leadership of medicine to rectify these aberrant and destructive practices.
HOWARD A. CORWIN
Center Lovell, Me., Sept. 21, 2014
The writer is a former clinical professor of psychiatry at Tufts University School of Medicine.
Leave it to Dr. Paul Farmer to use the word “optimistic” in reference to the Ebola epidemic. Writing in the Globe op/ed section, he and Joia Mukherjee, chief medical officer of Partners in Health, call for the kind of community health worker programs they use to fight another raging epidemic — drug-resistant tuberculosis.
Community care could, when coupled with infection control, stop the epidemic. Of course, the region needs more treatment units for the sort of care that can only be provided in an in-patient setting. And hospital care can be improved long-term only by training and equipping Sierra Leoneans and Liberians: the staff and the “stuff” required to save lives. But it also needs to provide the tools that smaller clinics and front line health workers need to fight the virus in their neighborhoods and villages…
Years ago, when Partners in Health first engaged in fighting another deadly epidemic — drug-resistant tuberculosis — our colleague Jim Yong Kim (now president of the World Bank) and others referred to it as “Ebola with wings.” We learned then, in settings from the slums of Lima to the mountains of Lesotho, that community-based care, delivered in large part by community health workers, was not only safer than facility-based care, it was also more effective. This was true when caregivers had the staff, stuff, space, and systems required to prevent, diagnose, and treat tuberculosis with the tools of the trade. “Community-based care” does not mean “community-based no care”: that, we’re providing already, and at large scale
Much for pet and bacon lovers at this years Ig Nobels, which were awarded Thursday night. Go to the source for worldwide coverage or check out Carolyn Y. Johnson’s blog post for the Boston Globe.
Thursday night at Harvard University, Nobel laureates took the stage to hand out the Ig Nobels, a satirical version of the Nobel prizes, which will be announced in early October. This year, the prizes were awarded in 10 disciplines, ranging from the physics prize for at last explaining why banana peels are slippery, to the medicine prize for using strips of cured pork to stop a gushing nosebleed…
■ Public Health: The award was split between two teams for an investigation of the mental hazards of owning a cat.
Czech researchers chronicled personality changes in young cat ladies and documented a decline in I.Q. and adventure-seeking behavior by men who were infected by toxoplasmosis, a parasite commonly found in cat excrement. A US team scoured medical records from 1.3 million patients and found that depression was relatively common among women who had reported being bitten by cats, and that screening those who had bitten by pets might be fruitful.
■ Biology: A team of Czech and German researchers are being honored for their finding that when dogs poop and pee, they prefer to squat with their bodies facing in a north-south line. Even silly results aren’t trivial to arrive at: the team observed 70 dogs, from 37 breeds. That’s nearly 2,000 defecations and 5,582 urinations over two years of smelly observation.
Also, a nod to Our Lady of Perpetual Condensation:
Neuroscience: In “Seeing Jesus in Toast,” a team from China and Canada have clinched the neuroscience prize with an exploration of a phenomenon called face pareidolia, in which people see nonexistent faces. First, they tricked participants into thinking that a nonsense image had a face or letter hidden in it. Then, they carefully monitored brain activity in the participants they managed to convince, to understand which parts of our minds are to blame.
A recent HHS ruling applies to a Massachusetts malpractice law promoting a new approach to dealing with medical errors.
Hospitals and health systems—not state lawmakers—will have to review their malpractice resolution programs in response to a recent Health and Human Services Department opinion on malpractice laws in Oregon and Massachusetts.
Both state programs encourage doctors to disclose medical errors, and to apologize and work with patients on potential out-of-court settlements. In response to a complaint about the Oregon law, HHS has ruled that payments under the programs need to be reported to the National Practitioner Databank.
New Hampshire recently adopted a similar approach and doctors in Georgia are working on a proposal. However, much of the activity in what one researcher calls “second-generation” malpractice reform is occurring at the hospital level, not at the state house level.
The programs go by different names: medical injury dispute resolution, sorry laws, disclosure and early offer, communication and resolution.
My latest for HealthLeaders Media looks at Public Citizen charges that a health screening program overstates the promise of its services. Public Citizen takes issue with company claims that cardiac screening saves lives. After issuing am initial statement criticizing Public Citizen as proponent of “government-run health care”, HealthFair now says it wants to work with regulators to ensure the accuracy of its advertising.
The debate over screening for heart disease and other conditions is playing out in a consumer group’s campaign to get hospitals to cut ties with the mobile screening company HealthFair Health Screening.
Last week, Public Citizen expanded its campaign by asking the Federal Trade Commission to investigate whether HealthFair’s promotional materials amount to deceptive advertising.A handful of hospitals have discontinued their relationships with Florida-based HealthFair after Public Citizen’s Health Research Group (HRG) accused the company of “fear-mongering.” In June, Public Citizen contacted HealthFair’s hospital clients and The Joint Commission to complain that company overstates the health benefits of its screening programs.
In the BBC’s Sherlock, the title character –played by Benedict Cumberbatch — often resorts to his “mind palace” to piece together nebulous memories.
In the film Eternal Sunshine of the Spotless Mind, a character played by Kate Winslet goes to a clinic to get painful memories of a relationship erased.
.A bit of a stretch, but add Frank Booth’s gas sniffing psycho from the film Blue Velvet, and you pretty much find nods to all the research Carolyn Y. Johnson talks about in her Globe column this morning.
In research published Wednesday in the journal PLOS ONE, McLean Hospital researchers took rats that had learned to fear a tone because it was followed by a foot shock and erased the negative memory, by having them breathe xenon gas. In a separate study, Massachusetts Institute of Technology scientists reported in the journal Nature they were able to use cutting-edge genetic tools to alter the emotional context of a memory, allowing them to replace the negative memory of receiving a mild electric shock with the pleasurable one of mingling with mice of the opposite sex.
That adds to a body of research from MIT over recent years that has shown that administering a drug can wipe out a negative memory in mice, or that it is possible to trigger an existing memory or plant a false one using genetic manipulation.