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Healthcare Part XVII – Malpractice Gone Wild

Three Kentucky lawyers are sitting in a Kentucky jail on multiple fraud charges in relation to a Fen-phen malpractice suit (a discredited diet drug).

After settlement the lawyers lied to the victims, and told some of the victims that discussing the settlement with anyone else was a criminal act subject to jail terms. Nice thing to do to sick people.

It seems that of a $200 million settlement the lawyers ate up $150 million or so, while lying to the victims about the terms of the settlement. There are allegations that the lawyers created a charity with a paid board seat for the state court trial judge.

This case got lots of publicity not because the victims were slammed but because the lawyers used some of the money to buy a piece of Curlin, a famous race horse from the 2006 season, while victims were still awaiting funds to pay medical bills.

There was a small amount of justice in the case when the lawyers started fightin amount themselves, over the money of course.

The federal district court trial judge will not allow the lawyers to post bail because they have been stonewalling about the whereabouts of some of the money.

I’ve thought for years that civil court settlements over $xx should be subject to a CPA review for proper distribution, and that all class action settlements should be reviewed. I’ve done this sort of review for a court when a juvenile was an accident victim. If everything is honest the cost isn’t that high.

This would, of course, drive the trial lawyers into a frenzy. But what about the victims?

Healthcare Part XVI – Ripping on Economists (gently)

Professors Paul Krugman and Greg Mankiw have stirred up the blogosphere recently with columns on health care. I think both of them are often wrong, as are many economists on many topics, IMHO.

Before I go on let me stipulate:

Both are smarter than I am.
Both are better educated than I am.
Both have better quantitative skills than I have.
Both have more resources than I have.

But both are wrong on healthcare issues.

How dare I challenge these respected giants of economics?

Thirty years of involvement in health care ranging from accounting for a single physician practice to working with national healthcare associations on broad policy issues. For starters.
And you will never see my byline in the NYT on healthcare issues.

In the US there is apparently a strain of thought that only lawyers, journalists and economists are generally qualified to comment as “experts” on a huge range of topics.

(I’ll rip on lawyers another day.)

Krugman and Mankiw have formidable skills and access to mountains of data. Both are adept at looking at those mountains, looking at the work of other economists and policy wonks, and drawing conclusions. I grant them their intellectual superiority.

But here is the question:

Can economists really use their skills and resources to be experts on such a wide range of topics?How much credibility should we give them?

Your comments.

Healthcare Part XV – More Trade and Buyer Beware

An increased amount of our pharmaceutical supply chain begins in China, sometimes as finished generic drugs, or medical supply items (diabetic testing strips) and often as pharm component chemicals. The big push to generics has created a bigger push for low costs.

There is a huge problem.

Apparently the same guys who do quality control for lead-painted toys do so for the Chinese pharm industry (sarcasm intended).

The FDA has been warning about deficient and counterfeit diabetic testing strips for some time. The consequences can be fatal. Phony or adulterated chemical compounds can as well.

How do you protect yourself from faulty generic drugs? I do not have a clue.

I checked witht he world’s greatest nurse. One safety check she uses is apparence when dealing with patent drugs. She knows what a Vicodin is supposed to look like, and if it comes out of the bottle with the wrong appearance futher inquiries are made.

But as to generics, spotting counterfeits is almost impossible she says. Generic hydrocodone-plus-tylenol (Vicodin) will look different depending on the manufacturer.

So what’s a consumer to do?

Deal with a pharmacy you know and trust.

If you are not certain about something, ask questions.

If you have serious side effects for reasons known or unknown, seek medical help immediately.

Be very wary of mail order (if you get your meds through your employer’s pharm benefit manager you are probably safer than personal Internet shopping).

As to genuine generics made with faulty chemical compounds, a lab is required.

The most likely impact of shoddy drugs is the drugs do not work as predicted. Less likely is that you end up in ICU or dead. Be careful.

Healthcare Part XIV: Medicare Payments, Politics and Patient Mix Ethics

Among proposals of the Bush administration is to cut future Medicare physician reimbursements by an average of 15% (10%, then 5%), actual cuts would vary by specialty.

This political game has been happening throughout much of the history of Medicare, but this proposal is a HUGE percentage.

(There is still an assumption by many that all physicians are wealthy, drive Mercedes, and etc. which is demonstrably not true, especially at the family practice and internal medicine level).

The AMA and the AARP have begun a major lobbying effort, and Congress will alter this (sometimes lobbyists do good things) eventually, solving the short run problem.

Medicare is also trying to cut reimbursements by denying claims, focusing on documentation rather than substance (and to be fair some providers should improve documentation, and there is fraud in the system). Medicare is also working on some interesting R&D projects on meshing quality and reimbursement.

Clearly Bush (and the next President) have to make adjustments to Medicare costs (or to revenue) but how and where is a difficult question. This is not the way!

In the way of background, Medicare has always had an underpayment methodology, seeking to have the program subsidized by private insurers (the term is usually “cost shifting” which makes an accountant wince, as it is really “revenue stream manipulation”). This is a covert tax system on non-Medicare patients.

A research colleague of mine has a burning concern, “is it ethical for a physician to limit Medicare and Medicaid patients in order to manage patient mix, and therefore manage revenue?”

Having managed physician practices, I think patient mix management is an economic necessity (especially in family practice), although most of the time it is not very effective, the local population drives the patient mix. This does lead some providers to denial of service to Medicare and Medicaid patients though, which is a gut wrenching call for the providers but may be an economic necessity.

(If physicians are lucky the Medicare and Medicaid patients are distributed about equally to providers just by happenstance.)

The questions are complex, the answers are complex. Change or innovation is unlikely until 2009.

Your thoughts?