Every one is a corrupt SOB

https://www.healthcare-now.org/wp-content/uploads/2014/05/2013CEOPayChart1.jpg

http://www.unitedhealthgroup.com/Investors/~/media/2B5EEC6F00F446AC9051674E259BA80B.ashx


 Here's some acid producing stuff for 2014--

CEO of ExxonMobil: $40 million

CEO of United Health Care: $12million

CEO of Aetna: $8.2 million

The CEO of Apple: $9.2million

UHC, take this job and shove it

I have tendered my resignation from United Health Care networks. Too much bureaucratic BS. It's all in my letter.

Just take note of the most recent news release on their 4th quarter profit.

http://www.unitedhealthgroup.com/Investors/~/media/2B5EEC6F00F446AC9051674E259BA80B.ashx

To: United HealthCare, Corporate National and Local offices

Friday, February 20, 2015

To Whom It May Concern,

After years of providing dermatological care for patients who possess health insurance from United Healthcare, this letter serves as your notification that I am resigning from your “provider panel” for all the networks and products you offer. I will no longer serve as a physician providing care to patients under United Healthcare. As of today, I am severing our relationship without cause, with three months’ notice per customary protocol.

I will communicate this to my patients currently enrolled with United Health Care. However, 90 days from today, beginning on May 20, 2015 I must not be listed on your online provider search engine, website, nor portals;  nor listed as a provider in any print or electronic communication with patients nor the public at large after that date. 

My experience as a physician with you has been extremely frustrating in the past 18 months. As long as you collude with the federal government, you have no risk and considerable profit, and billions of dollars are being siphoned that should have gone directly to patient care. Your medical care ratio ending in 2014 is 79.8%, meaning that 79.8% of the income from premiums is devoted to payment for medical claims. Where does the other 21% go? Perhaps in efforts such as expanding Optum; paying dividends to your shareholders and bonuses to your CEO; lobbying the government for more bailouts; or hosting coffee talks and sending glossy brochures to enroll more Americans, ignorant of your mercenary and crony capitalism ways.  

I have witnessed the decline of the public perception and personal experience with the United Health Care company as a whole, where patients had reasonable cost coverages and the website was easy to navigate. The trend for the past several years has been of skyrocketing deductibles, copayments and prescription costs, a cumbersome website that doesn’t verify coverage in a reliable real time fashion-- then we’re left with unanswered questions in the medical office because a person cannot be reached on your byzantine phone system. Shame on you for denigrating physicians, dismissing us summarily, without an explanation from your Medicare Advantage networks, leaving thousands of patients in the lurch and without alternatives, more confused than ever about their insurance status. Your reasons were couched publicly and online as promoting quality initiatives, but they were clearly cost control measures where patients were sacrificed and they did not obtain medical care, thus saving you money and promoting profits. Not one person from your company explained or ensured a transition would happen. Patients still are confused about this, 18 months after my letter was received and 1 year after it took effect, and they have been lied to and manipulated as a statistic point in your pursuit of federal dollars. I see what you are, and I want no part of it. 

Costs have escalated while benefits, and reimbursement, have plummeted. In light of onerous deductibles, complicated online password-requiring preauthorizations and online/paperwork deluge for pathology or lab testing, I find I can no longer practice medicine while under your provider list. Instead I am a navigator of insurance/medical/pharmacy bureaucracies.This is not coherent with my professional mission nor values. Thus, I am tendering my resignation from all of your networks. 

Sincerely, 

Dr. G

Close the gap and some navel-gazing

There is a huge push for payment for quality, payment for outcomes. Neither of these are defined in any sort of consistent, concise fashion. Not for one single diagnosis across the board in medicine.
It fails to take into account that the patient is the one and only arbiter of what goes into the mouth, what smokes go into the lungs, etc. Physicians are no more responsible for the behavior of patients than the plumber is responsible for the behavior of your toilet or the auto mechanic for your car. Nobody is addressing the fact that we don't have cures or favorable outcomes for everything. People all will eventually die. Mortality is a metric that dares not be breathed into any discussion.

Health care in this country isn't really about prevention, we can try to prevent every bad thing but people will, and can get, randomly--or genetically determined--illnesses such as lupus or leukemia. We need to differentiate between sick care and health care. Doctors promote health by treating and sometimes even conquering illnesses. But we generally don't go out there and lay waste to every cigarette counter at a local supermarket or set fires to Dunkin Donuts. Do these items promote health? No. But it's a free country and I will not agree with your cigarette and donut, but I will defend your right to get it. I will not participate in any insurance plan that requires my clicking of a box on smoking cessation counseling or trans fat free dietary management.

Grow up People!!!!

Yesterday I lost my patience with patients.

On the whole, I see and deal with people of all walks of life, all ages, all ethnicities. They may be ill with infections or cancer, or they may be the worried well. It's all the same for doctors everywhere in clinical practice.

I have a snowbird patient I saw once 4 months ago. She was given a prescription for imiquimod by her dermatologist in a another state prior to my seeing her, and not to my knowledge. She's 89 years old, she proceeded to use this with wild abandon on her face last month. She got very irritated and rashy, bleeding and crusting, and so she called me for help. Fine, she's here temporarily and I can manage the necrosis caused by a drug I didn't prescribe, nor am I in agreement on its being used by a geriatric patient with a history of traumatic falls and who doesn't have a permanent address. But I digress. A patient is in distress, I know I can help. ****Polyanna music to cue here*****

I see the patient, examine the horrible facial crusts, take a culture, prescribe an oral antibiotic, a topical steroid for the itching, and lots of rest and gentle cold compresses with topical OTC antibiotic ointment. I advised her that the local pharmacy in my area would certainly have the prescriptions available. She told me she lived in the next town over and would use a national store's pharmacy, it shall remain nameless except it's a big box that offers $4 prescriptions for CERTAIN drugs.
She calls my office 4 hours later to chew me out that "the oral antibiotic costs $4 and is a reasonable price, but the cream is $90 and I won't get it". This is the 756th patient to do so this month.

This is where the doctor sees red.

I was on the phone, listening to her rail, and her complaining ad nauseam about the costs of drugs---then I lost it. I told her I had no more patience to deal with her complaints and that she had to figure it out herself.

PHEW.

I am pissed that I have to be the arbiter of sick care costs, prescriptions costs, and all the while be cheerful and compassionate and sympathetic. No more. I am done and I will not respond to queries about drug costs or preauthorizations. Go complain to the govt and see if they'll treat your cancer while you're at it, your infections, your neoplastic processes.....I'm DONE DONE DONE. I'm a doctor, not a financial analyst, data acquisition specialist nor pharmacy advocate. I'm sick of the lies, you were promised free or cheap drugs, you could keep your doctor, you could keep your plan, all LIES. I hate this!!!!

Corruption

I've been reading with dismay and exhilaration the research done by Dr. Wes, a cardiologist who took it upon himself to audit the American Board of Internal Medicine and the finances and Foundations it controls. It's truly unreal, they're racketeering off of internal medicine doctors, threatening them with crashed careers for lack of re-certification.

It's the stuff of nightmares. The ABIM had purchased a 3-bedroom luxury condo in the historic downtown of Philadelphia for "board members to use for meetings to save on hotel costs". They decided to sell this property and it's listed at $2.3 million. At a very generous $400 per night hotel room charge, for maybe 10 nights for 12 people, the cost is $48,000. Extremely high, but nowhere close to $2.3 million. Why the purchase?

Perhaps there was so much money lying around that they had to invest in real estate for tax purposes.

Think about. It was the money of hard working doctors financing the Marie Antoinettes of the ABIM. I would support the revolution to topple this monarchy. Check it out...


http://drwes.blogspot.com/2014/12/the-abim-foundation-choosing-wisely-and.html

Leviathan has run amok

Governmental staff have been growing at exponential rate. I wonder if the largest employer in the USA is still the government....I see and hear from a different bureaucrat every time I have contact with the local, state or federal tax office, or the local or state health dept., etc. Or is the turnover so great? I think not, once they go to work for the govt they're in for life, generally speaking. There are just too many of them and not enough of us little people actually working and generating goods and services to the world. Pithy observation for the day.

Some truth buried elsewhere...

This Ebola thing is truly shocking. Not how infectious or deadly the virus, but the btched and slapdash platitudinous drivel flying out of the mouths of bureaucrats.
I read the CDC recommendations, and found no hard data nor details on what to do as a doctor if I suspect Ebola. So,  I looked online and found a revelatory letter from Infectious Disease Week.
Here it is in its entirety. In the interest of promoting data sharing and info, the entire article, which is an annotated version of a talk given by the Emory physician in charge of their Ebola unit, for lack of a better term. Emory took on the care (successfully) of Dr. Brantly and Ms. Writebol, the medical missionaries airlifted from Liberia back in August 2014.

EBOLA: LESSONS LEARNED, FROM IDWEEK 2014

Jump to: - Planning for the care of patients- Clinical Care- Experimental Interventions- Laboratory Testing and Diagnostics- Surprises in Shipping- Staff and Environmental Safety- Personal Protective Equipment- Unexpected Adventures in Waste Management- Media and Communications- Lessons Learned- References

A summary of the presentation at IDWeek by Dr. Bruce Ribner on caring for Ebola patients in the US [1]. Dr. Ribner led the team at Emory University that cared for two patients with Ebola virus disease (EVD) in August. In light of the recent Ebola cases in Dallas and Spain he agreed that a summary could be provided to assist ID specialists in their ongoing preparedness efforts.

Planning for the care of patients

This involves the entire institution, and needs many sections to coordinate their work. EMS services were an important coordination point for the transport of the 2 patients to Emory. On the medical staff, many types of expertise were needed for clinical management: ID, critical care, anaesthesiology and several other subspecialities. Nursing, environmental management, facilities, security and media relations were all intensively involved ahead of time so that expected roles were defined. Even so, there were times when questions arose after the patients arrived.

Clinical Care

Ebola patients in Africa have only limited clinical evaluations and essentially no laboratory testing due to the lack of any infrastructure to support this. The Emory team was able to make careful clinical evaluations over time in their 2 patients and Dr. Ribner summarized the main points as follows:

1. Despite weight gains of 15-20 kg, the patients were profoundly hypovolemic due to their low serum albumin and vascular leak with third spacing. Fluid losses in their patients were 5-10 L/day.
2. Electrolyte losses were significant and included profound hyponatremia, hypokalemia and hypocalcemia. At initial assessment at Emory the patients were one week into illness yet these were their first laboratory determinations. Arrhythmias were noted, and both intravenous and oral electrolyte repletion was necessary.
3. Nutritional depletion was evident as well.
4. Ebola virus RNA was detected in blood, urine, vomitus, stool, endotracheal suctioning and semen and on skin. It was not detected in dialysate. Environmental testing in the patient rooms had no detection of viral RNA and included many high touch surfaces such as bed rails and surfaces in the bathroom.
5. Intensive 1:1 nursing care was necessary around the clock. Patients were monitored continuously and this level of nursing care allowed for rapid response to clinical changes. Nursing and other team members provided emotional support, and as the patients improved, help with self-care and physical therapy.

Experimental Interventions

While there are no approved vaccines or treatments for EVD, the WHO has noted that it is ethically acceptable to consider use of experimental agents. Categories of agents under study include candidate vaccines, whole blood and immune serum, and novel therapeutic agents (monoclonal antibodies, antivirals and RNA-based drugs). Most have not been evaluated in phase 1 human studies and are in limited supply. The Emory team engaged the FDA, CDC and pharmaceutical manufacturers in active discussions as they weighed additional interventions.

Laboratory Testing and Diagnostics

Differences in guidance for laboratory testing were noted between CDC and ASM. The CDC guidance indicates that testing can be performed in a main lab with attendant infection control and analyzer safeguards that are specified by the instrument’s manufacturer, while the ASM guidance specified that point of care (POC) instruments located very close to the patient should be used. The reality the Emory team noted was that if a specimen from one of their EVD patients spilled in the main lab, it would be closed for hours to accomplish decontamination, thus impacting function of the entire hospital. There was realistic concern that technologists would not perform testing on EVD blood. These considerations prompted the Emory team to set up a POC testing area adjacent to the patient care unit[2]. Lab testing was kept to a minimum.

Surprises in Shipping

Ebola virus is considered a category A agent which requires special packaging and shipping arrangements for clinical specimens. Despite meeting these requirements, the Emory team learned that commercial carriers refused to transport the specimens even when the carriers were licensed for Category A agents.

Staff and Environmental Safety

The hospital safety officer needed to navigate multiple regulatory requirements at the federal, state and local level. Familiarity with the regulatory documents and jurisdiction was necessary.

Personal Protective Equipment

Their staff was trained in the use of PPE that included impermeable body protection (gown, leg and shoe covers), face mask or N95, eye and face protection (goggles and face shield) and gloves. Practical considerations led them to use full body suits and PAPRs. Their decision was based on the need to work for extended periods of time using PPE, the aim of decreasing physical discomfort working in multi-component PPE and the avoidance of difficulties like fogged faceshields. The donning and doffing of PPE was always observed by another staff member, and the importance of adhering to safe removal of PPE was emphasized.

Unexpected Adventures in Waste Management

Although the CDC guidance indicates that sanitary sewers are acceptable for patient waste, the local water authority disagreed. The Emory team had to disinfect all patient liquid waste with bleach or quaternary detergents for 5 minutes before it could be flushed. The hospital’s waste disposal contractor would only pick up materials that were certified as free of Ebola virus. As a consequence, the hospital had to dedicate an autoclave and move it to process all materials used in clinical care in order for it to be accepted for disposal as regulated medical waste. By the end of the patients’ stay the autoclaved and boxed materials filled several trailers.

Media and Communications

Three key messages were used to manage the tsunami of media attention: first, that the Emory team had expertise in treating serious infectious diseases; second, that the staff and hospital were trained and prepared to care for the patients; and third, that the preparations included protection of Emory patients, staff and the community. Patient confidentiality was also underscored. For the hospital staff, multiple communications were done, using town hall meetings, email and other modes. For inpatients and all new admissions, letters were given that explained the situation and reiterated the key messages, and senior administrative leaders delivered the messages as well answered questions. No decrease in admissions or elective surgeries at the hospital was noted.

Lessons Learned

Patients with EVD can be safely cared for in developed countries with appropriate safeguards. This opportunity affords close clinical observation and experience in clinical management that could be relayed to facilities with lesser infrastructure. Communication, both internal and external, is critical to manage the situation surrounding a hospitalized EVD patient.

The Society thanks Dr. Ribner and his team for their astute observations, their compassion and their willingness to share what they have learned.

Sincerely,
Barbara E. Murray MD, FIDSA, President, IDSA
Stephen B. Calderwood MD, FIDSA, President-Elect, IDSA
Marguerite A. Neill, MD FIDSA, Chair, Rapid Communications Task Force, IDSA