Monday, June 09, 2008

21st Century Alchemy... Still a Failure.

The only thing surprising about this article is that it is, evidently, surprising to the author.

* Just found this... Orthopedic surgeons may be leading the charge. Will the government listen to the experts who actually fix people, or will it tie them to the rack?

** And meet my hero.


  1. At my old ER clinic we'd take 'collateral' if folks didn't give a visa number up front--so our back room often had an interesting mix of snowboards, mountain bikes, etc. For about 2 months we had to count a Rolex in with our narcotics each day until buddy payed up. We had less than 5% accounts in arrears. Who needs Teamsters when you've got aggressive receptionists??

  2. They have been doing the triage/medical screening exam successfully at hospitals in our area. You get paged to the cashbox (aka triage room) to do a medical screening exam.

    Beginning to dream...
    The power is intoxicating. It is easy to imagine oneself as a Roman Emperor, and with a thumbs up the patient (with a worthy, truly emergent condition) goes to the best technology and care in the world. A thumbs down (for the complaint of "brain rushes for a year") tosses them to the lions of the billing department, where the carnage of getting the patient separated from their cashy money ensues. The battle is over when the final words are "I'm gonna call my F-@&ing lawyer" and the shower of torn up billing documentation feathers gently to the floor.

    Back to reality...
    The patient whips out their Medicaid card and flashes a grin reminiscent of a Mastercard - Priceless commercial, with more tats and less teeth. Chief Complaint... toothache for 3 months. Allergies to everything but the DP's ... Demerol, Dilaudid and Percocet. Pain scale 21 -- out of 10.

    But, there is hope. The paleolithic, concrete-brained worshippers of Press-Gainey in the carpeted section are beginning to pull their heads out of their collective auto-colonoscopy procedure and legally circumvent EMTALA. Could the dream of Hospitals dropping medicare and the associated alphabet soup of regulations and mandates be realized?

    Dare I dream?

  3. Ahhh...cutting out the middle man. It's worked for the 'discount' warehouses why can't it work for medicine. I like my COD. No hassle, just pay up sucker.

  4. This toothless crack whore malingering with her sickle cell calls 911 today 20 out of 10 pain of course, "only dem d- drugs work fo me. Dat dem-bob-did drug. I's 'lergic to the rest of dem" She tells me "I gots insurance. You wanna see my card?" Sure, I said.

    Meanwhile, I'm thinking 'what amazing employer PPO does being a crack whore have? BCBS? Aetna? Mailhandlers? Or Tricare? Sucking dicks probably warrants the HMO buy-up. Easier to get specialist referrals that way.'

    She pulls out the familiar medicaid card. "Here's my in-surance card." Fed up, tired, and needing to piss for the last 45 minutes, I looked right at her three teeth and said, "You ain't got no motherfucking insurance. I GOT INSURANCE ON YOU."

    This threw the crackwhore for a loop. "Peckerwood! You done seen my insurance card. How you be sayin' I aints gots no insurance. What the fuck is this shit here?"

    I told her, "That card isn't insurance you have. It's insurance I pay for. My already paltry paramedic check gets bled dry so those of us with jobs can pay for people like you to be healthy and productive members of society. And clearly, these stop-gap measures are amazingly productive considering what you've done with your life."

    It was a beautiful speech. But she didn't hear it. Shorlty after that "you people" comment, shit hit the fan and she started screaming. So we called for PD, she kicked a cop, bit at me, and the police gave her a little stick time. She went to jail, insurance card in hand.

    With clients like this, I can't imagine why physicians would shy away from medicare.

  5. As a 3rd grader I got the part of the doctor in "Hans Brinker and the Silver Skates". The guy who won't save Han's dad until he gets his cash up front. What a great role, the hisses of the crowd were so sweet.

  6. From the article on cash only:

    "Health insurers downplay the trend,"

    I suppose this is similar to politicians downplaying the lack of voters on election day. "It isn't a trend, the voters probably had to go to the ED for something important. They value our contribution to society."

  7. Hey, igloodoc; you mentioned that, "The battle is over when the final words are "I'm gonna call my F-@&ing lawyer" and the shower of torn up billing documentation feathers gently to the floor."

    Uh huh. And what lawyer have you retained who does not require a fee up front for his or her services?

    Oh, but your lawyer has a right to charge a fee. I am just here to save your life, so I do not deserve compensation for my services.

  8. countyrat: The road is full of ambulance-chasers who will line up to take her case on a no-fee basis, counting on their ability to force you (or your insurer) to settle. They take 1/3 off the top then deduct all expenses from what's left. Often the "client" ends up with less than the lawyer, but when you're on welfare a few grand is a fortune.


  9. I thought it was 40% before they take out expenses, leaving not much.

    The other thing is they have the settlement include a nondisclosure clause, which makes a mockery of the lawyers claim that they work to protect people. If they worked to protect people they would insist that these dangers to society be exposed.