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Brian Klepper on predatory health care

Brian Klepper, CEO of The National Business Coalition on Health, has written a good piece on tackling predatory healthcare. Click here to read it. He writes, “When predatory anecdotes…come to light, the benefits managers – or better yet, the CFOs – of local employers, unions and

The face of evil in healthcare

Dr. Farid Fata, whose picture is in the linked article in the Detroit News, pleaded guilty to diagnosing people with cancer, and giving them high doses of chemotherapy, in essence poisoning them, when in fact they did not have cancer. His is the face of pure evil in health care. The author, Oralandar

Good news on Virginia Mason and Geisinger Health

An article in Modern HealthCare describes a new and promising development.  Jaimy Lee is the author. Virginia Mason Medical Center in Seattle, WA, is offering warranties on knee and hip replacement.  Writes Lee, “Patients who undergo routine hip or knee replacements at Seattle’s Virginia Mason Medical Center,

Some Cancer Experts See ‘Overdiagnosis,’ Question Emphasis on Early Detection

Thus reads a headline in a WSJ report (subscription required). Melinda Beck is the author. She writes, “Early detection has long been seen as a powerful weapon in the battle against cancer. But some experts now see it as double-edged sword.” Further, “…some leading cancer

Do you want to see where some medical fraud dollars go?

Just click here. In the case of David Nicholl, $5M want to a muscle care collection, $700k went to his girlfriend’s apartment, and $154k went to strippers, according to the Yahoo story. Quite a guy, no? Your health dollars at work.

Brian Klepper on predatory health care

Brian Klepper, CEO of The National Business Coalition on Health, has written a good piece on tackling predatory healthcare. Click here to read it.

He writes, “When predatory anecdotes…come to light, the benefits managers – or better yet, the CFOs – of local employers, unions and governmental agencies should immediately call the health plan and demand that the health systems, physicians and other providers involved be removed from the provider panel.”  (Emphasis mine.)

His article links to a terrific piece by Elisabeth Rosenthal in the New York Times entitled “After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know.”  That article chronicles how an innocent patient, Peter Drier, a bank technology manager in New York City, through absolutely no fault of his own was caught in a billing scheme that can only be described as predatory. The list of villains in this story is as long as your arm.

In the NYT article look at the devious and ultra expensive stunt an assistant surgeon named Dr. Harrison T. Mu pulled off. The $117,000 billing came from him whom the patient never met nor was treated by. What happened to the patient could happen to anyone who reads this post.

YOU SHOULD READ THIS ARTICLE. Brian Klepper’s advice is right. Demand that these types of providers be taken off your provider panel.

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Tom Emerick

Cracking Health Costs, the book, an Amazon best seller, is available on Amazon at a deeply discounted price. Click here: Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care by Tom Emerick and Al Lewis.

Tom Emerick is the President of Emerick Consulting and co-founder of EdisonHealth. In December 2012, Tom was listed in Forbes.com as one of 13 unsung heroes changing healthcare forever. In 2009, Tom was named by Healthspottr as one of the top 100 innovators in healthcare in the US for his work on medical ethics. Prior to consulting, Tom spent a number of years working for large corporations: Walmart Stores, Burger King, and British Petroleum.

 

The face of evil in healthcare

Dr. Farid Fata, whose picture is in the linked article in the Detroit News, pleaded guilty to diagnosing people with cancer, and giving them high doses of chemotherapy, in essence poisoning them, when in fact they did not have cancer. His is the face of pure evil in health care.

The author, Oralandar Brand-Williams, wrote that Fata “...was accused in August 2013 by federal authorities of giving chemotherapy to patients who didn’t have cancer as part of an alleged scheme to bilk millions out of Medicare. He pleaded guilty Tuesday to health care fraud, money laundering and conspiracy to give or receive kickbacks.”  

Fraud? Money laundering? Conspiracy? Sounds more like a RICO case than medical harm. Is the right word for this “Medical Mafia”?

He “faces up to 175 years in prison and a $250,000 fine on the health care fraud counts and up to 20 years and a $500,000 fine for money laundering.”

Let’s hope he gets the full package. But my question is why wasn’t he on trial for assault, poisoning his patients, and murder? Did the prosecution team have no spine?

Furthermore, a whistleblower exposed him to the authorities in 2010. They didn’t incarcerate him until 2013! Are Detroit Feds really that slow? How many people continued to be poisoned in the interim years?

BTW: He collected $139 MILLION from Medicare before being stopped.

How about setting up a special task force to go after the medical mafia?  A good place to start would be to look at doctors who’ve collected over $130M in chemo claims from Medicare.  Maybe a little audit would be in order?

Was this mutt in PPO networks? If so why? People in his office had to know this was going on.  Why aren’t they being prosecuted?

Overdosing patients with chemotherapy is nothing new, but usually at least they have cancer.  Narrow networks can help prevent this.

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Tom Emerick

Cracking Health Costs, the book, an Amazon best seller, is available on Amazon at a deeply discounted price. Click here: Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care by Tom Emerick and Al Lewis.

Tom Emerick is the President of Emerick Consulting and co-founder of EdisonHealth. In December 2012, Tom was listed in Forbes.com as one of 13 unsung heroes changing healthcare forever. In 2009, Tom was named by Healthspottr as one of the top 100 innovators in healthcare in the US for his work on medical ethics. Prior to consulting, Tom spent a number of years working for large corporations: Walmart Stores, Burger King, and British Petroleum.

 

Good news on Virginia Mason and Geisinger Health

An article in Modern HealthCare describes a new and promising development.  Jaimy Lee is the author.

Virginia Mason Medical Center in Seattle, WA, is offering warranties on knee and hip replacement.  Writes Lee, “Patients who undergo routine hip or knee replacements at Seattle’s Virginia Mason Medical Center, and their employers, now can worry less about paying twice if surgical complications occur.

“That’s because the hospital has decided to offer a warranty to privately insured patients on avoidable complications stemming from total joint replacements, making it one of the first hospitals in the nation to do so.”

Virginia Mason is a true innovator and leader is excellence in healthcare on the West Coast. They keep raising the bar.

Further, “Geisinger (in Western PA) start(ed) providing warranties on elective cardiac surgery in 2006, and (soon) plans to announce that its program has been expanded to cover the costs of hip fractures and total hip and knee replacements.

Both Virginia Mason and Geisinger are key centers of excellence in the EdisonHealth Centers of Excellence program. You are seeing here why more and more payers see them both as top referral centers in the US. Let’s hope other facilities follow the path of Virginia Mason and Geisinger.

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Tom Emerick

Cracking Health Costs, the book, an Amazon best seller, is available on Amazon at a deeply discounted price. Click here: Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care by Tom Emerick and Al Lewis.

Tom Emerick is the President of Emerick Consulting and co-founder of EdisonHealth. In December 2012, Tom was listed in Forbes.com as one of 13 unsung heroes changing healthcare forever. In 2009, Tom was named by Healthspottr as one of the top 100 innovators in healthcare in the US for his work on medical ethics. Prior to consulting, Tom spent a number of years working for large corporations: Walmart Stores, Burger King, and British Petroleum.

 

Some Cancer Experts See ‘Overdiagnosis,’ Question Emphasis on Early Detection

Thus reads a headline in a WSJ report (subscription required). Melinda Beck is the author.

She writes, “Early detection has long been seen as a powerful weapon in the battle against cancer. But some experts now see it as double-edged sword.”

Further, “…some leading cancer experts say that zealous screening and advanced diagnostic tools…” That in turn can lead to treating harmless abnormalities which can involve chemotherapy, radiation therapy, and surgery, all based on over diagnosis.

Says Laura Esserman, a breast-cancer surgeon at the University of California, San Francisco, “…We’re not finding enough of the really lethal cancers, and we’re finding too many of the slow-moving ones that probably don’t need to be found.”

This is not news to regular readers of Cracking Health Costs, but simply affirmation of the maxim, Patients Beware.

Hat’s off to Malorye Branca for the tip on this story.

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Tom Emerick

Cracking Health Costs, the book, an Amazon best seller, is available on Amazon at a deeply discounted price. Click here: Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care by Tom Emerick and Al Lewis.

Tom Emerick is the President of Emerick Consulting and co-founder of EdisonHealth. In December 2012, Tom was listed in Forbes.com as one of 13 unsung heroes changing healthcare forever. In 2009, Tom was named by Healthspottr as one of the top 100 innovators in healthcare in the US for his work on medical ethics. Prior to consulting, Tom spent a number of years working for large corporations: Walmart Stores, Burger King, and British Petroleum.

 

 

Do you want to see where some medical fraud dollars go?

Just click here.

In the case of David Nicholl, $5M want to a muscle care collection, $700k went to his girlfriend’s apartment, and $154k went to strippers, according to the Yahoo story.

Quite a guy, no? Your health dollars at work.

Even more good news: CMS reverses bad decision

In May of this year, CMS announced it would no longer publicly report certain types of adverse patient events in hospitals, a sad day for transparency.

Thanks in no small part to the rigorous efforts of the Leapfrog Group and it’s excellent leader, Leah Binder, CMS has reversed that decision.

Kudos to Leapfrog and Leah Binder for working hard to protect patients.

__________________________________________________________________________

Tom Emerick

Cracking Health Costs, the book, an Amazon best seller, is available on Amazon at a deeply discounted price. Click here: Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care by Tom Emerick and Al Lewis.

Tom Emerick is the President of Emerick Consulting and co-founder of EdisonHealth. In December 2012, Tom was listed in Forbes.com as one of 13 unsung heroes changing healthcare forever. In 2009, Tom was named by Healthspottr as one of the top 100 innovators in healthcare in the US for his work on medical ethics. Prior to consulting, Tom spent a number of years working for large corporations: Walmart Stores, Burger King, and British Petroleum.

Great news: the launch of Care Innovations’ Validation Institute

The launch of the Care Innovations’ Validation Institute, a joint initiative between GE and Intel, is a major step forward in the world of population health management…a genuine game changer.

GE and Intel are doing what the government has failed to do, which is help employers determine which vendors actually do something — and that it is a direct challenge to the wellness industry to prove they can do anything other than overdiagnose and potentially harm employees with too much medical care. Maybe GE and Intel can ignite a wave of responsibility in corporate America, reversing the misguided mania of “playing doctor” with your employees.

The goal is to “help organizations involved in population health – from Health Plans to Employers to Vendors of solutions to the industry – adhere to the highest standards of validity, allowing them to compete on the basis of integrity and performance.”

The Institute will “impartially challenge the status quo of typical population health outcomes measurement, with the objective of impacting how the industry establishes its credibility over time. To achieve this objective, we seek cooperation from across the healthcare industry – only through cooperation can we start to move the industry to a place of trust and credibility.”

The Care innovation’s Validation Institute was founded because of the massive amount of misinformation put our by vendors in the world of population health management. Readers of Cracking Health Costs will recognize the need for this: vendors which claim impossible ROIs, make absurd interpretations of data, etc.  Examples Al Lewis and I have used are wellness vendors who claim to reduce risks of heart attacks by over 100%, or who claim to have discovered huge numbers of people with previously undetected cancer, both of which were later determined to be gross errors at best or outright fraud at worst.

If you are a population health vendor whose business is fueled by ridiculous outcomes claims, beware.

__________________________________________________________________________

Tom Emerick

Cracking Health Costs, the book, an Amazon best seller, is available on Amazon at a deeply discounted price. Click here: Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care by Tom Emerick and Al Lewis.

Tom Emerick is the President of Emerick Consulting and co-founder of EdisonHealth. In December 2012, Tom was listed in Forbes.com as one of 13 unsung heroes changing healthcare forever. In 2009, Tom was named by Healthspottr as one of the top 100 innovators in healthcare in the US for his work on medical ethics. Prior to consulting, Tom spent a number of years working for large corporations: Walmart Stores, Burger King, and British Petroleum.

Why Doctors Are Sick of Their Profession

A recent essay in the WSJ (subscription required) discusses why doctors are sick of their profession.

The article explains that doctors:

  • have to work harder to make a living
  • don’t get the respect they they used to get
  • are in a profession “just like everybody else”
  • made sacrifices but but their work is just a job like every one else’s
  • etc.

How are they different from everyone else? Up until about 1980 or so, if you were an business school, engineering school, etc, graduate and went to work for a company, you likely:

  • had a job for life
  • were well respected
  • had a defined benefit pension
  • were treated like an asset to your company
  • worked a forty-hour week

These days MBA’s and masters level engineers at the same companies are working 50-60 hour weeks, battle every day to dodge the next 10% staff reduction, provide for their own retirement through 401k’s, will likely have to change jobs 5 times in their career, and know they are perfectly expendable.

In many high-paying big companies, the day they hire you they shoot a bullet at you. Your job is to see how long you can outrun it.

Employees, despite how hard they worked to get a good job, are stressed, dissatisfied, and fearful.

The cushy days ended years ago for most people.

__________________________________________________________________________

Tom Emerick

Cracking Health Costs, the book, an Amazon best seller, is available on Amazon at a deeply discounted price. Click here: Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care by Tom Emerick and Al Lewis.

Tom Emerick is the President of Emerick Consulting and co-founder of EdisonHealth. In December 2012, Tom was listed in Forbes.com as one of 13 unsung heroes changing healthcare forever. In 2009, Tom was named by Healthspottr as one of the top 100 innovators in healthcare in the US for his work on medical ethics. Prior to consulting, Tom spent a number of years working for large corporations: Walmart Stores, Burger King, and British Petroleum.

 

Hospital charges $9,000 to bandage cut middle finger, report says

Yes, you read that headline correctly. According to a Fox News report, a man went to the Bayonne Medical Center with a cut on his finger. Per the article, “…he was sent home after he got a tetanus shot from a nurse practitioner who also sterilized the cut, applied some antibacterial ointment to it, and put a bandage on it.”

He bill was nearly $9,000. Sounds like the hospital “mugged” the patient.

The CEO of the hospital, Mark Spektor, gave an absolutely hilarious response when questioned about the charge, He said the patient’s “… visit cost so much because his insurance carrier United Healthcare refuses to offer fair reimbursement rates.” (Emphasis mine.)

The CEO’s comment is the ultimate non sequitur. So the hospital charged an outrageous fee to an innocent patient because…what?…Bayonne Medical Center doesn’t like United’s fees? How absurd.

I’ve written about cowboy doctors who are wasting hundreds of billions in healthcare dollars.  There are cowboy hospitals too.

__________________________________________________________________________

Tom Emerick

Cracking Health Costs, the book, an Amazon best seller, is available on Amazon at a deeply discounted price. Click here: Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care by Tom Emerick and Al Lewis.

Tom Emerick is the President of Emerick Consulting and co-founder of EdisonHealth. In December 2012, Tom was listed in Forbes.com as one of 13 unsung heroes changing healthcare forever. In 2009, Tom was named by Healthspottr as one of the top 100 innovators in healthcare in the US for his work on medical ethics. Prior to consulting, Tom spent a number of years working for large corporations: Walmart Stores, Burger King, and British Petroleum.

Get off the fence and chose sides

It is time to get off the fence and choose sides. Corporate benefit managers, listen up.

This is part 2 of a recent post about Dr. Sandeep Jauhar’s welcome expose’ of poor healthcare in America, in his book, “Doctored: The Disillusionment of an American Physician”

His book is an important one, but on key issues he wants to have it both ways.

On the one hand he laments physicians who order expensive, invasive, and futile care for patients even when the patients clearly don’t want it. On the other hand he complains about his frustration with having to get authorization from insurance companies for care he wants to deliver to his patients. Those two notions are mutually exclusive.

Equivocation on important healthcare problems has created the healthcare chaos we have today. Concerned parties need to choose sides, especially corporate benefit managers.

BWT: “Medical school applications have risen by 38% from 2003 to 2013,” according to an article in the WSJ by Thomas Stossel.

__________________________________________________________________________

Tom Emerick

Cracking Health Costs, the book, an Amazon best seller, is available on Amazon at a deeply discounted price. Click here: Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care by Tom Emerick and Al Lewis.

Tom Emerick is the President of Emerick Consulting and co-founder of EdisonHealth. In December 2012, Tom was listed in Forbes.com as one of 13 unsung heroes changing healthcare forever. In 2009, Tom was named by Healthspottr as one of the top 100 innovators in healthcare in the US for his work on medical ethics. Prior to consulting, Tom spent a number of years working for large corporations: Walmart Stores, Burger King, and British Petroleum.