Poem of the Day

The Pronouncement

His still, angular form
Lies upon the bed
Clad only in the hospital gown
And his socks

When he pulled them onto
His feet this morning
He could never have conceived
That they would offer
Far more tangible evidence
That he once was
A breathing man

Than that
Still, angular form
Which once
Contained him

Ezriel Kornel

Medicare editorial from BackTalkLive

Just as I was preparing my editorial on medicare, CNN asked me for an interview about my perspective on medicare. What did I tell them? It's a SHAM because it doesn't pay doctors who want to practice quality medicine enough to stay in practice. So how can they stay in practice? From the income private insurance pays. This means that medicare is a subsidized insurance program, like a charity. Primary care doctors either have a patient mill with a squad of physician extenders such as nurse practitioners and physician assitants (most are very competent) working for them or they can't make a living. That's why so often you don't even get to see your doctor or if you're lucky, maybe for five minutes and that's after waiting for an appointment for a ridiculous amount of time. I, a surgeon, opted out of medicare because I didn't want to support a sham. It doesn't come close to even covering my costs so I want my patients to know the truth. I ask them if they can pay a reasonable fee, I never want them to go broke but I want to at least cover my expenses. If they can't pay anything and are determined to have me perform their surgery, I will do my best to work something out. Not all doctors are prepared to do this, they just can't carry the losses. If my only reimbursement was medicare based, I would have to perform over 500 operations before I saw a penny of it myself. None-the-less I always give the best of myself no matter whether my over 65 patients can pay or not. Most of my patients do choose to pay because they want to feel good about selecting the doctor of their choice. With medicare further cutting payments, more doctors will be forced to opt out and patients will all have to pay more out of pocket or receive second class medical care.

New Orleans Saints

Who knows in what fortunes and misfortunes God chooses to intervene but yesterday he/she must have felt compelled to support the Saints in their efforts to bring forth a miracle. The city of New Orleans, a city of great tenacity in the face of great adversity, will be uplifted by this miracle and we should all celebrate, even those from Indianapolis, the efforts of strong and determined people to acheive their loftiest goals.

Helping in Haiti

My partner and I volunteered immediately after the earthquake to offer our expertise in Haiti. We tried to do so through multiple organizations as well as the White House. We were placed on a list but I am certain that there were many physicians throughout the world who also volunteered to provide assistance. The problems, of course, were many. Getting to Haiti was at first a major challenge and planes with doctors could not even land. Furthermore, there were no facilities initially for providing medical care for the seriously injured. The first physicians to arrive were those who already had disaster management experience. Sadly, any patients requiring neurosurgery due to head injuries would have had to receive attention within hours. Certainly, individuals with spine injuries may still require stabilization procedures and many are being transfered to the USS Comfort or to Miami. We know, however, over the coming months and probably for next couple of years there will be individuals in Haiti who suffer injuries and illnesses that require neurosurgical intervention. I hope that all who have offered their expertise in the acute phase of this disaster will be willing to help as future needs arise.

Poem of the Day

Two Cats and Me

There are two Cats in my room and Me
One is a small, gray and white ceramic cat
Fiddling atop a round, yellow box
For tiny mementos
The other is a great big gray one
Just now lying in the doggie bed licking his paw
Sometimes he lies on top of me when I lie in bed
Purring as I stroke his chin and chest and
That spot just behind his ear
The three of us
Sharing this room


Ezriel Kornel

1/30/10

Insurance companies once again trying to increase profits on the backs of consumers

Well, the health insurance companies in New York have a new trick up their sleeves. Until very recently, insurance companies have been paying doctors who are "out-of-network" fees that are based on usual and customary rates (UCR). They usually pay 70 to 80% of these UCR and the patient is responsible for the difference between what the doctor charges and what the insurance company pays. The insurance companies used to determine UCR based on numbers established by a company they themselves set up. Attorney General Andrew Cuomo felt this was not appropriate or fair to the consumers because there was a conflict of interest and because the UCRs they set were lower than the actual UCRs as determined by analyzing true physician's fees. Under this old scheme patients had to pay more out of pocket. With the new methodology, insurance companies will have to pay more and consumers less. So the insurance companies decided to pull a switcheroo and stop basing reimbursements on UCR . They have been sending letters out to their subscribers telling them that they will now make payments based on medicare rates, the maximum pay-out being 140% of medicare fees. Medicare fees are woefully inadequate especially for reimbursement of surgical procedures. There is no way that physicians, especially surgeons can lower their fees to a fee anywhere close to 140% of medicare. Therefore, the consumer will now be out-of-pocket for far, far greater an amount then they had been with a UCR based fee.
If the insurance companies think that by pulling this switcheroo they will be able to force more doctors "in network" they are mistaken. Groups such as ours, will, in fact have to close the office doors if reimbursements are based on Medicare rates. We have far too great an over-head to be able to cover this over-head and still make an adequate living.
So, some physicians will move or retire and those left will have to try to maintain fees adequate to provide the revenue they require, leaving the patient to pay more out-of-pocket. The only way this miserable scenario can be avoided is for consumers to inform their insurance companies and their elected officials that this is unacceptable.
Both the insurance companies and the government want to change the way health-care is delivered, each for their own purposes and in the end, it seems, to the detriment of most patients.

Ignorance is bliss---not

Oh, how loudly people are screaming (the pundit Palin once again expressing opinions without comprehension of the facts) that now the government wants to decide who lives and who dies. First, its "the government wants to provide health-care to one and all" and suddenly its "the government wants to withhold health-care from the old and sick." Well, it reminds me of the old joke about the Ignorantans vs the Jesuits but its a long joke and I won't repeat it now. Suffice it to say that there are complex and appropriate arguments on both sides of the health-care debate but ranting against the one unequivocally appropriate and important provision in the health-care bill brought forth by the House is an accolade to ignorance. There are governments that believe they have the right to determine how money is spent when they are giving away "free stuff." Both Great Britain and the state of Oregon, for example, have made decisions not to treat certain illnesses that have an extremely low likelyhood of recovery. But this is not what our legislature has in mind, it wants to educate people, a seemingly radical idea. Who wants to remain ignorant about what treatment options we have when we get really sick and are likely to pass on to the next world? The answer should be "no one." Someone may want to be on a ventilator with IV's and catheters and multiple medications if it allows them a few more hours of life even if they are comatose. Another person may choose to have no treatment and even withhold nurishment if they are in a condition that will not allow them to live a life which allows them a measure of independence along with normal cognition and communication. Both have the right to their exit strategy but unless they know how to communicate their wishes to the health-care system, they will all be kept alive to the very end and sometimes even beyound. The bottom line is when an individual understands their choices, expresses those choices clearly to someone else and then identifies that person to their health-care provider than there is a high likelyhood that their wishes will be honored. This empowers the individual and is that not the core of conservative ideology? We have the added benefit of not having to waste large sums of money on unwanted treatments. Is this a case of everyone wins? Yup, it sure is.