Injuryboard Commentary - Medical

Why are Medical Bills so High?

Jon Lewis — Sat, 05 Dec 2009 13:49:34 GMT

Did you know that hospitals and physicians rarely ever receive the amount they charge for their services? Health insurance companies do not pay the actual bills invoiced by medical professionals. Why is that?

We had a client who was injured in a truck collision. His injuries were serious enough to warrant several nights in the hospital and a couple of surgeries. What were his medical bills? Approximately $72,000.00. What did the hospital and physicians get paid? $11,714.01, approximately 16% of the amount billed.

If you had a retail store, would you accept 16% of your prices? Why do hospitals and doctors? Are they over-charging, or are they getting paid too little?

What if you don't have health insurance? What happens then? Well, I can tell you that I handled collections for a hospital about 13 years ago, and if patients came in for emergency treatment and didn't have insurance, we sued them for the full amount, not 16%. Why do private pay individuals have to pay the full amount? I understand why health insurers receive a discount, but an eighty-four percent (84%) discount? What if Bill Gates doesn't want to get health insurance? He can pay any amount billed so why doesn't he receive the same discount as a company like BlueCross?

Is this a form of fraud or misrepresentation? In Alabama, BlueCross BlueShield has such a monopoly on health insurance that they dictate to hospitals and physicians what they can charge for their services. Many doctors speak poorly of BlueCross BlueShield as a result of their influence. Some won't even accept their rates as a result. Should the health insurance companies be setting the rates for medical treatment? Is that capitalism?

I don't have the answers to all these questions, but I think they need to be discussed, especially in light of healthcare reform. What are your thoughts?

Originally posted at InjuryBoard by Jon Lewis

Pharmaceutical Companies Use Rx Data Mining to Boost Sales Tactics, Patient Advocates Argue

David Mittleman — Thu, 03 Dec 2009 16:06:36 GMT

When your doctor prescribes you a medication you probably expect that the information stays between you, the doctor, and your insurance company. However, prescription data miners are changing that dynamic in scary ways: by spying on your prescription data they are able to provide pharmaceutical companies with information to entice doctors to prescribe their medications more frequently. In fact, pharmaceutical companies are able to learn how to “fine-tune” their messages so that when a sales-rep calls a doctor, they are able to give a good pitch. Furthermore, pharmaceutical companies can entice doctors to prescribe their medications with free samples of drugs. While the individual identities of patients is not disclosed in data mining, government officials are concerned about doctors’ decision-making becoming distorted because of the new sales tactics of pharmaceutical companies with access to prescription information.

The process of prescription data mining begins with medical data firms. Medical data firms have access to billions of prescription records, which they purchase from pharmacies and health insurers who have physician data from the American Medical Association, as well as other sources. They then are able to sell this information to pharmaceutical companies. According to critics, the end result is that drug companies are able to sell their newest and costliest medications, not necessarily the most effective medications.

Patient advocates and government officials are also concerned about the interference in the patient-doctor relationship, as well as increased spending on expensive drugs. However, data miners argue that they are actually helping contain the cost of prescription medications by improving quality and by quickly providing doctors with information on which drugs work best.

Originally posted at InjuryBoard by David Mittleman

Outrageous hospital billings.

Gerry McGill — Wed, 02 Dec 2009 17:37:29 GMT

Ever wonder why hospital bills are so high? Consider these: Patient Jim Bujalski complained to St. Anthony's Hospital in Littleton, CO, about the cost of his prescription Plavix and Crestor tablets, which he was forced to "buy" while hospitalized. He could not use his own medications beause the Hospital only "administers drugs under its own control". The Plavix was $248 each, (he pays $8 at home) and his Crestor was $65($3 at home). That's a mark-up 31 times for Plavix and 21 and 2/3 for Crestor. The medications were part of his $58,000, one-day hospital stay.

Further, Medical Billing Advocates of America, a private firm that patients can hire to help consumers sort through their medical bill for errors, over-billing or outright fraud, has reported patients bills that contain a $2 box of tissues billed as a "mucus recovery system" for $12, a piece of gauze used to wipe down surgical equipment billed as a "fog eliination device" for $57, and a Teddy Bear billed as a "cough support device" for $57.

Medical Billing Advocates of Florida estimates that as many as 80% of all medical bills contain billing errors of some type but a spokesman for Humana, a health insurance company that receives about 6 million claims a month says that 90% of the bills do not contain errors. Assuming that neither advocacy group is totally correct and the difference is somewhere in between, there are certainly many, many errors made. Call me a cynic, but I can't help but believe that the number of overbillings greatly exceed errors in the patients' favor.

Originally posted at InjuryBoard by Gerry McGill

Cancer Misdiagnosis and Its Consequences

John Cooper — Wed, 02 Dec 2009 13:04:00 GMT

According to American Cancer Society, 565,000 people in the U.S. died of cancer in the year 2008 alone. It is estimated that anywhere from 8% to 12 % of these cancer cases were initially misdiagnosed. A cancer misdiagnosis can greatly affect the lives of the patient as well as that of the family. It causes emotional and mental suffering, asi well as the fact that it creates a significant financial strain on all involved. In some instances, the misdiagnosis may have debilitating consequences as result from potentially unnecessary chemotherapy, radiation and surgery. Death or the loss of a substantial chance of survival is another common harm from delayed cancer care.

Every patient has the right to seek a physician’s second opinion. During your examination, never be afraid to ask questions concerning the laboratory and medical procedures. However, once confirmed it is imperative to start treatment immediately.

Cancer misdiagnosis may include:

Improper identification of a tumor as non-cancerous;
Improper labeling or handling of a biopsy specimen;
Failure to routinely check at risk patients;
Failure to review the medical history of the patient's family when considering symptoms and making a diagnosis;
Improper grading of cancer in terms of severity; and
Failure to refer a patient to a specialist.

Regardless, always feel free to seek a 2^nd opinion prior to any treatment of cancer. Obviously, this should be done quickly as time is of the essence. If this protocol has been followed you have probably minimized the likelihood of a misdiagnosis. However, if after reading this article you feel there may be a chance that you have been misdiagnosed, you should seek knowledgeable legal counsel to determine your rights.

About the Editors: Shapiro, Cooper Lewis & Appleton personal injury law firm is based in Virginia (VA), near the NE North Carolina (NC) border and handles car,truck,railroad, and medical negligence cases and more. Our lawyers proudly edit the Virginia Beach Injuryboard, Norfolk Injuryboard, and Northeast North Carolina Injuryboard as a pro bono public information service. Lawyers licensed in: VA, NC, SC, WV, DC, KY.

Originally posted at InjuryBoard by John Cooper

Let's Get Real About Lawsuits and Corporate America and Organized Medicine

David Mittleman — Wed, 02 Dec 2009 10:11:39 GMT

While browsing the blogging world I discovered a post by Joanne Doroshow on the The Huffington Post with which I completely agreed. Ms. Doroshow was taking on the hypocrisy of Corporate America and Organized Medicine when it came to their positions on access to the courts.

It boils down to this. When it's injured people who want access to the courts to protect what little rights they have left after "tort reform", corporate America and organized medicine blast the anti-litigation propoganda for all to hear. We hear about frivolous lawsuits, costs of litigation, and the threats to commerce.

But... when it's corporate America and organized medicine that want access to the courts to rack up money on even the most absurd claims, the anti-court propoganda disappears. Most likely, these corporate entities are suing smaller, weaker entities to squeeze them out of money over things most of us would probably shake our head over.

So here's the truth. When you hear television ads and see online postings talking to you about frivolous lawsuits and greedy plaintiffs, remember who is sending you the message. It's probably a corporate entity that's been suing over the craziest claims, but doesn't want injured persons without million dollar bank accounts to have access to the courts.

Is that hypocrisy? If it walks like a duck, and talks like a duck....

Originally posted at InjuryBoard by David Mittleman

Database of Medical Malpractice Unavailable to the Public

Paul Thomson — Tue, 01 Dec 2009 21:13:24 GMT

Tulsa World reported that there is a national database of medical malpractice data that the public is unable to fully access. The database is maintained by the U.S. Department of Health and includes about 460,000 records of malpractice lawsuits. However, the public can only view the lawsuit's allegations and the patient's health, while the remaining information is only open to hospitals, managed care organizations, and state licensing agencies.

The American Medical Association believes the information should remain private because it is unreliable. Supposedly, data is often submitted late and some of the information is untrue or misleading. The AMA argues that it is a flawed program. However, many individuals believe that this is just a way to protect doctors. The information should be available to the public because people have a right to know if their physician has been involved in a medical malpractice claim. Medical professionals need to be held accountable and potential patients should not be kept in the dark. If the patient is able to obtain this information he or she can then question their doctor about it and make an informed decision as to whether they wish to remain under the doctor’s care.

Originally posted at InjuryBoard by Paul Thomson

FDA Trying to Reduce Preventable Medical Error from Prescription and Over the Counter Drug Use

David Mittleman — Sun, 29 Nov 2009 10:39:08 GMT

Over 3 billion prescriptions are written annually in the United States, and tens of millions of people rely on prescription and over-the-counter (OTC) drugs to sustain their health. With such high numbers of drugs being used, the risk of preventable medical error from improper drug combination or the misuse of medication has led the Food and Drug Administration (FDA) to start the Safe Use Initiative.

As my Virginia-based colleague Greg Webb noted, the initiative calls upon doctors, health care professionals, and even patients to help the FDA identify specific, preventable medication risks and develop interventions to such risks. The initiative has a goal to implement some interventions within the first 12 months of the Initiative's existence.

Among the target groups the Initiative seeks to protect is children. One study cited by the FDA found that over 9,000 children were exposed to prescription opioid drugs from 2003 to 2006. Just as startling was the fact that 60,000 emergency room visits occur annually as a result of unsupervised ingestion of medication by children under the age of 12.

Some of the changes consumers can expect will be better information of the prescription and OTC drugs they take, including the proper dosage to take along with calibrated spoons or cups that are easier to read and correspond with the product's packaging.

Originally posted at InjuryBoard by David Mittleman

Straight Talk on Tort Reform from Texas

Bret Hanna — Mon, 23 Nov 2009 23:20:37 GMT

Texas passed sweeping tort reform legislation in 2003 that, to a great extent, eliminated medical malpractice cases in the Lone Star State. Jennifer Bard is the Alvin R. Allison Professor of Law and director of the Health Law Program at Texas Tech University School of Law and an adjunct associate professor in the Department of Psychiatry, Texas Tech University School of Medicine, and she incorporates the Texas experience with tort reform into her analysis which concludes that such measures do not reduce health care costs. Here is her piece which appeared Saturday in the Houston Chronicle:

It's not as rare as you think for President Barack Obama and Gov. Sarah Palin to be in complete agreement on an issue of national importance.

In August, she wrote on her Facebook page that “we cannot have health care reform without litigation reform.” Speaking to the American Association of family physicians a few weeks later, President Obama said, “I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs. ... So I am proposing that we move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine.” Both of them are wrong. There is no evidence to suggest that limiting the rights of individuals to bring lawsuits will either lower the cost of health care or increase its quality. In fact, were this true, Texas would have the cheapest and best health care in the nation. The provisions of the tort reform legislation passed in 2003 have essentially eliminated medical malpractice suits. Indeed, things are so bad the lawyers for the insurance companies are complaining about the loss of business.

The only evidence we have that defensive medicine, defined as doing extra tests or surgery based on fear of litigation, drives up costs is from the least reliable source possible — the doctors themselves. Doctors' objections to law suits aren't financial — they are philosophical. Doctors are on the whole good people who devote their lives to helping others. Yet somewhere in their training they acquire the idea that this puts them beyond the constraints and hassles faced by every other professional. Lawsuits are time-consuming and embarrassing. They require explaining one's actions to a group of nondoctors, something doctors feel inappropriate. What doctors want isn't reform, it is an exemption. And that's just not how we do things in the United States.

As in all other cases involving a professional, every medical malpractice case depends on another physician's testimony that the offending doctor caused the patient's harm by acting below the standard of a reasonable physician in similar circumstances. To say that a jury isn't qualified to choose the testimony of one expert witness over another in a medical malpractice case is to say they shouldn't be allowed to do so in cases involving exploding tires because they are not automobile engineers. Unless Obama and Palin are interested in trading in our legal system for one with less citizen input — say one more like China's — then not only isn't litigation reform a necessary part of health care reform, it is no part of health care reform.

But don't throw out the baby with the bath water. Perhaps doctors are practicing defensive medicine, but that doesn't mean litigation reform will change their habits. First, it is hard to attribute overtesting to fear of litigation when the current payment system financially rewards doctors and hospitals for the number of tests they order and procedures they run, rather than on the time they spend talking to the patient to find out what's wrong. Second, it is entirely possible that those interested in selling them malpractice insurance have greatly inflated the risk. After all, given the relative rareness with which medical malpractice suits are brought, fear of litigation should no more be motivating a doctor's decisions than fear of alien abduction.

No one has ever suggested that civil litigation can directly reduce medical error. Reducing infection rates by adopting uniform protocols for hand-washing and instrument sterilization is not the same as pressuring a company to withdraw a defective product from the market. But our system of civil justice, as outlined in the United States Constitution, is not to blame for health costs or medical malpractice. Health reform can take place without litigation reform — both systems may be broken but they are not dependent on each other.

So perhaps if Obama and Palin really want to lower the cost of health care and improve its quality, they should be listening to economists and safety experts rather than either doctors or lawyers.

This analysis is spot on and from someone who does not appear to have "skin the game." Yes she is a lawyer, but not one that makes her living representing those injured by medical malpractice or working for the insurance companies that hire lawyers to defend doctors when claims are pursued against them for malpractice. We should consider her analysis in the objective light in which it is presented.

Originally posted at InjuryBoard by Bret Hanna

Defensive Medicine: There Is Someone On The Defense All Right

Mike Bryant — Sat, 21 Nov 2009 17:07:00 GMT

The conservative blogs are loaded with talk of tort reform. We here at the Injuryboard continue to write about it. Guess the claim that no one is talking about it, is not only false, but intentionally misleading. It's interesting, how many of these posts get a comment with a link to the town hall site, which is claimed to have all of the answers. I spent some time looking at the link and it really does defy logic.

There is a section on defensive medicine and the very next section is entitled: "There Is No Proof That Threats of Litigation Deters Injuries" . What?????????????????? The reality is that while they use some facts, they stretch those facts and push frivolous arguments to come to a conclusion that fits for them. Even their damages charts distort the numbers to include extra fees that I would guess is the defensive medicine that actually the plaintiff was injured from. I would expect the executive compensation or medical charges costs includes even less for the injured consumer.

If you still have questions spend a little time with the American Association for Justices paper on the issue of the defensive medicine claim.

Ask the tough questions:

What tests are doctors doing that are actually not needed?

Have they ever found cancer or other medical life threatening issues with those tests?

Who got the money for those tests?

Why are so many people still dying in American hospitals?

Would more tests actually reduce the number of claims and keep more consumers alive?

My guess is that anyone claiming the existence of these tests really won't want to answer these questions. Mainly, because it simply doesn't happen and if it does they are involved in FRAUD. But, let's keep talking about it.

Originally posted at InjuryBoard by Mike Bryant

What You Do At the Scene of a Car Accident Can Make or Break Your Personal Injury Case

John Cooper — Sat, 21 Nov 2009 12:05:22 GMT

Odds are you will be involved in a car accident at some point in your life. In fact, The typical person will be in 4.5 wrecks on average in their lifetime. The National Highway Traffic Safety Administration (NHTSA) estimated that 2.35 million people were injured in a car accident in 2008 alone. If you find yourself involved in even a minor accident what you do at the scene may determine how smoothly your recovery process goes later on.

Get All the Facts

Once you have pulled your car to the side of the road and called for emergency assistance it is time to start collecting information. There is no such thing as too much information in a car accident. Talk to the other driver. Get their insurance information, name, address, license plate number and driver’s license number if you are able. Talk to the police. Ask for a business card and an incident number. This number will help you obtain a police report later on. Locate any witnesses that remained at the scene. Get their name, phone number and address so your lawyer can contact them about your accident. Also, be sure to jot down any information you can about the accident including the speed and direction you were traveling and any facts you can remember. If you injuries are severe enough, then you may not be able to do all this investigation, so if possible call a friend or relative to come help you at the accident scene.

Do Not Take the Blame

Car accidents can be jarring and often victims are not thinking clearly while their adrenaline is pumping. Even if you think you are to blame for the accident, do not accept liability. Do not discuss the accident with the other driver or any witnesses, only the police. There may be factors in the accident you are not aware of.

Seek Medical Attention

Adrenaline not only causes you to think unclearly, it can also mask pain. The police officer will ask you if you are hurt or need an ambulance, so be sure to tell him if you are hurt, or if unsure, tell the cop that you don't know the extent of your injury, but will drive yourself to the doctor. Even if you think you are not seriously injured you should still see a doctor. Many people sustain injuries in car accidents they were not aware of at the time. Be sure to tell the doctor if you are nauseas, light headed, dizzy, confused, disoriented, or have tinnitus as these could be a sign of a serious medical condition.

It is important that you seek medical attention as soon as possible. The longer you wait to see a doctor the easier it will be for your insurance company or the other driver to argue that you sustained your injuries after the car accident.

Hopefully you will never be involved in a car accident, but if you are, spend your time wisely. Get all the information you can, be careful not to accept liability, and see a doctor as soon as you are able. Remember that some information may be hard to recover after you leave the crash scene, like the names and numbers of eyewitnesses.

About the Editors: Shapiro, Cooper, Lewis & Appleton personal injury law firm (VA-NC law offices ) edits the injury law blogs Virginia Beach Injuryboard, Norfolk Injuryboard, and Northeast North Carolina Injuryboard as a pro bono service to consumers.

Originally posted at InjuryBoard by John Cooper