Tuesday, May 10, 2011

This isn't Russia is it?

Congratulations Tennessee. Your state government, "TennCare" specifically, has just invited a large portion of it's board certified Emergency Physicians to pull chocks for greener pastures. You see, TennCare, doomed from the start on the principle that the problem with socialism is that eventually you run out of other people's money, has now run out of other people's money (for the Nth time), and is now coming to take more money from the doctors providing care.

With the stroke of a pen, legislators have defined out of the "emergency medical condition category" about 2,000 medical diagnoses (like tuberculosis)... They have been kind enough to write these conditions down so we will know ahead of time that we will be reimbursed $25 if we diagnose a patient with one of these conditions. The document is 220 pages of single-spaced, small-font SHIT.

This article laments that many providers will simply stop seeing TennCare patients. No doubt they will. But in the ER, and at the one where I occasionally guest-star... There is no option to stop seeing TennCare patients. It would abrogate federal law under EMTALA... And you try turning the "non-emergency" cases away... You better be 100% right pal or you are going to jail, or court, or both.

And once again, nowhere in the debate, is there ANY discussion about what recipients of their neighbor's largesse need to do to DESERVE this entitlement. What's that? They are deserving because they are disabled, poor, old, infirm, or unemployed? Okay, and how many TennCare patients, each year, are able to improve their circumstances enough to come off TennCare? What incentive is their for them to do so? None? So you kick of the kid with cerebral palsy because he's costing TennCare too much money? Wonder if the TennCare administrators are making some
sweet jack... My bet is yes, they are, and they all talk and talk and talk, but they don't do CPR.

I tell you who IS incentivized right now... All my colleagues in EM in Tennessee... Incentivized to leave the state. Let the legislature argue how to get three Emergency Physicians to cover 100 departments. I know, let's staff the ERs with independent mid-level practitioners. That will save a lot of money. Hey docs, how many times are you going to take this before you stand up and shout or simply walk away?

And somehow this applies, but I'm too tired... Enjoy.


  1. Only good thang thats come out of Tennessee was Elvis, oh wait, he was from Mississippi, the other state where you can marry your sister, I mean shoes, I mean 46 chromosomes are optional...
    And I might be a little prejudiced cause I've still got some outstanding Volunteer State(What a shitty motto)speeding tickets from 1984, you remember 1984, when America had an honest-to-God MAN in the Whitehouse, a guy not afraid to give Arab Terrorists a new A-hole right in the forehead...
    Oh yeah, a Big Orange Fan(check for the epicanthic folds) smacked me in the Haid' with a big Orange at the 1980' Auburn-Tennessee game, which Auburn lost 42-0 cause they were still playing white guys at cornerback...
    seriously, I hadnt seen a beatin like that since someone stuck a Banana in my shorts and turned a Monkey loose...
    and speakin of Monkeys...
    how come "Every Which Way But Loose" didn't win an Oscar?? Oh yeah, no Homo Cowboys...
    And be honest, 9-11 if the President(Born in the USA!) said Lane Kiffin was Bin Laden's Gay Homosexual Lover you woulnd't be surprised...
    Seriously, Kiffin beat feat out of Tennessee faster than James Earl Ray, I mean AlGore...


  2. You gave nice ideas here. I done a research on the issue and learnt most peoples will agree with your blog. Certainly, these practices are unfair; but they say that most of their rules are only to apply to people who overdraw.

  3. Frank, when making a naked self portrait, was observed to overdraw.

  4. Palliative Care Doc4:57 PM, May 11, 2011


    This is why the powers that be should actually visit ED's and do some research before initiating this kind of plan. Unfortunately, that will never happen, as they would always get the VIP treatment.

    I would say "Come to Texas!," but our executive branch thinks we are building a moat around us, which may hinder travel.

  5. What the fuck is wrong with people?

    Let's tell everyone they can go to the ER regardless of what's wrong with them and ability to pay. Let's completely subsidize routine and emergency care for a large proportion of the population and require no copayments. Basically, let's convince a fuck ton of people they are entitled to take, take, take whatever the hell they want or need and then... when we realize we can't grow money on trees... we'll just arbitrarily redefine the cost of these services. You see, if you pay healthcare providers less, healthcare won't be expensive! GENIUS! We are so clever that we made these services cost less, because now it doesn't matter if we mistreat doctors! If they leave, it doesn't matter, they don't do anything of value anyway! Hurrah!!!