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Bioidentical Hormone MD - Erika Schwartz Discusses Your Love Life 'Sextistics' – Sunday on TLC for Valentine’s Day

2/13/2010 10:48:00 PM  ,  

This looks like it can be a fun show and entertaining.   Last year I had time to speak with Dr. Erika and we talked about Bioidentical hormones.  I learned quite a bit

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from the interview and agree with her demand to get some numbers on FDA approved bioidentical HRT and Premarin.  This video below is a clip from the Good Day Show talking about the program.  

Bioidentical Hormone Replacement Therapy– Interview with Dr. Erika Schwartz

There are several FDA-approved drugs that are bio identical to include Estrace, Evamist, Vagifem, Estraderm, and Climara for estrogen and Prochieve, Prometrium, and Crinone for progesterone.  After my talk with Dr. Erika I want to know how these stack up to Premarin, give us some numbers to compare as I have used the “FDA APPROVED BIOIDENTICAL” patches for HRT. 

FDA Approved Bio Identical HRT Versus Premarin and Cancer – Where’s the Numbers FDA and Pharma?

When many today seem to think of bio-identical hormones, we automatically believe that they are only drugs compounded by the pharmacy, and that is simply not true. Bioidenticals are synthesized hormones that mimic those produced in women's ovaries, more natural than those produced from horses.

Wyeth Used Ghostwriters - Video of the Premarin Horses

Dr. Erika and I talked some serious issues but this video presentation (trailer here) looks like it could be fun taking a look at the amorous side of what a correct adaptation of hormones can mean.  BD

 

Dr. Erika has an upcoming special "Sextistics: Your Love Life" which will air on TLC Sunday February 14th Valentines Day.

Dr. Erika | Bioidentical Hormone Expert: 'Sextistics' with Dr. Erika Schwartz

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Political Debate On Former President Clinton and the Stents – These Guys are Distracted And Have No Clue On How to Allow Stents to Be Affordable As Well as Drug Treatments

2/13/2010 12:35:00 PM  , ,  

I thought this was somewhat humorous and ridiculous at the same time.  Here we are again looking at cost on drugs versus stents and there needs to be an open path to have both available.  Why don’t they tackle why stents are so expensive as the companies are so tied up in fighting patents, and other legal areas, it all gets passed down to us.  This announcement didn’t impress me in the least and now you read about Boston Scientific laying people off.  Get a clue!

J and J Gets 1.7 Billion Wins Battle, Doctors, Hospitals and Patients Lose on the High Cost of “Legally” Patented Stents

This is just one example of many.  Did you know that due to the cost of stents that many hospitals cannot pay for them upfront?  Instead the stent manufacturers put them there “on consignment”, in other words there’s no charge to sit on the shelf until the stent is used.  This is one example of some of the cost cutting efforts hospitals are having to make today, as their costs are fixed in many areas like this, they need to have the stents available.  

So with this lawsuit reward somebody has to pay and it’s us, and we have tied the hand of one other company who develops stents with cash flow issues.  If I were J and J on this, I would maybe consider some big donations to helping healthcare after this announcement.  We pay the price for “legally patented” stents that are approved by the FDA long before this nonsense takes place.  Sure a settlement may be in order, but for goodness sakes this large? 

Ok J and J, start donating some free stents for those who cannot afford them with this big landfall of money and for the folks in this video, start working on some constructive priorities, your disruption is not doing anybody any good other than adding to the ridiculous chatter on the web.

Have a chat with J and J and see if perhaps something nice can come out of this stockpile of money.  BD   

This morning, Fox & Friends covered President Bill Clinton’s hospitalization by asking if the President would have been treated for his heart problems “if the health care reform had gone through.” “Would he have gotten those stents?” host Brian Kilmeade asked in-house health reform expert Peter J. Johnson Jr.

Think Progress » Fox Politicizes Clinton’s Heart Surgery, Suggests He Wouldn’t Have Received Treatment Under Health Reform

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FDA Grants Extended Use of Crestor For Use With Patients Without High Cholesterol – Watch The Side Effects

2/13/2010 11:49:00 AM  ,  

The Jupiter study was one that literally shook up healthcare and one of the potential side effects is diabetes and muscles that hurt with the use of statins, but it appears the FDA says it’s ok for our muscles to hurt as you are going to lower your odds of heart disease, so us as patients need to have this discussion now to figure imageout if this is right for us, an individuals. 

FDA Committee Agrees With Wider Use of Crestor – Is The Jupiter Study Data Creeps Up Once Again

If you are not familiar with the Jupiter report and how this all came about, a fellow blogger, the Happy Hospitalist was kind enough to lay it out for us with his thoughts on how one treatment has the potential to lead to other drug treatments, so again we are back to the patient/doctor conversation about whether or not Crestor and statins are the answer and what the risk of developing diabetes could be.  The muscle pain seems to be pretty well documented all over the web from patients who have experienced this side effect.

The Jupiter Report with Crestor – What Side effects?

Many physicians recommend taking an enzyme called COQ10, which is naturally found in our systems and with a supplement as I understand it, this helps the body create additional supplies of the enzyme in our system and offers relief for the muscle pain.  There’s the “Tomato” pill that has been released on the market to help with muscle pain, or I guess you can start eating a lot of tomatoes too to help generate more COQ10 in your system.

The Tomato Pill for the Treatment Of High Cholesterol

If you want to read up a little further on COQ10, you can use the link below.  It has been discussed in medical journals and has not been discounted, but carries the tone of still being somewhat of a “mystery” according to studies at Brigham and Women's and Harvard Medical. 

Statin Side Effect Test: Worth the Price?

So now that Crestor can be prescribed to those who do not have elevated levels of LDL in their system, but have other risk factors, this really makes the use of the drug something you want to evaluate and again talk with your doctor.  Do your risk factors with heart disease merit taking the drug and dealing with the side effects and the possibility of developing diabetes?  Right now there’s an all out war going on with care and prevention of diabetes, so again take a look as it would be a shame to develop diabetes if that is going to be the payoff for lowering odds for heart disease.  If heart disease did occur is it better to go have a stent implanted if that is the determined treatment, or take drugs?  People with diabetes have heart disease too.  Is it best to chuck Crestor and take the natural enzyme COQ10? 

This new expanded prescription level for Crestor gives us all a lot more to read up on and to consider as through studies and patient information we are not blindly taking a drug without knowing up front what some of the trade-offs could be.  BD 

The FDA has broadened the approved use of Crestor, a cholesterol-lowering medication typically used in patients with elevated levels of low-density lipoprotein (LDL) cholesterol and triglycerides. By reducing large amounts of these substances, the statin drug has been proven effective in reducing the increased risk of heart disease associated with high cholesterol. The FDA’s newly approved indication allows Crestor to be used in patients without high LDL cholesterol who illustrate other risk factors for cardiovascular disease.

The new approval stems from a clinical trial referred to as the Justification for the Use of statins in Prevention: an Intervention Trial Evaluation Resuvastatin (JUPITER). In the JUPITER trial, the use of Crestor was examined in 18,000 older patients who did not have high LDL cholesterol levels but illustrated other risk factors for heart disease. Patients in the study who took Crestor experienced a 44 percent reduced rate of non-fatal heart attack, stroke and arterial revascularization compared to patients given placebo. All patients examined in the trial were men and women at least 50 and 60 years of age respectively. All lacked clinical evidence of heart disease and high LDL cholesterol levels, but all had levels of high-sensitivity C-reactive protein (hsCRP) above or equal to 2 mg/L, a potential cardiovascular disease risk factor.

Side effects associated with Crestor in the JUPITER trial were generally similar to those previously associated with the medication, with joint pain being one of the most frequently experienced adverse reactions. In the study, patients taking Crestor developed diabetes at an unexpectedly greater rate than those taking placebo. Nevertheless, patients with impaired fasting glucose, which is often a precursor to diabetes, still illustrated a lower risk of experiencing serious cardiovascular complications when taking Crestor in comparison to those taking placebo.

Crestor Now FDA-Approved to Prevent Heart Disease in Patients without High Cholesterol | Drugwatch.com

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Will Marry For Health Insurance Web Site – Nobody Cares, Responds, The Reality of A 30 Second Attention Span

2/13/2010 09:42:00 AM  , ,  

This is pretty interesting when you listen to the video.  On the “Will Marry for Health Insurance Site” she talks about opportunities she has had come her way, but has not made a move and is basically asking via the video, what is the right thing without putting herself first, something novel we don’t see too much of today in imagethe self serving world we live in, so good to know that is not dead and that people who try to make a difference still exist without political undertones.  She just wants to be heard and hopefully bring around an awareness. 

I do give her some credit here for drawing attention to the insurance problem.  What is funny is that when you read on she states there are over 7,000 men who have written and like anything with the internet, there’s a lot of junk in there, and when you get right down to it, there’s even more junk behind the scenes. With the high level of distraction and disruption we live with today, there’s a ton of those in there.  I see it in my business contacts with people too.  For about 30 seconds they see something of interest, take 30 seconds to respond, and then they are on to something else, never to return here as it was only something in passing that caught one’s attention.  Reality of this, this is the average attention span today on the computer, about 30 seconds and it happens to all of us, people with good intentions but wrapped up in so many other areas, you just never get back there. 

She’s probably ending up with a lot of men who want to make a “30 second difference” here, but that’s not what she is looking for, so the process of sifting all of those out takes time.  This is very much similar to an online dating site, you get the same thing.  This maybe not to say this is a lost cause but it is more like finding a needle in a haystack and can end up being nothing more than “cheap” entertainment of sorts.  The fact that she is doing in to bring attention to the problems with healthcare is valid though, because take this same scenario today with insurance, same distraction, same disruption, and you get insurance carriers and companies that can also only give a 30 second difference, (how long it takes for the algorithm to run) which again is not solving anyone’s problems. 

The internet has brought more choices to us today and has also created disruption with values we have known for years and we have an entire world struggling with the same issues.  As you read through here, she’s getting many people who are having the same problem and asking her to continue to be as voice. 

Anyway, this is something to give some thought to, as aggregating people data certainly can leave on feeling very short of being able to attain a goal, it presents opportunities that may not have existed before, but again those are on there for 30 seconds and what is being sought here is a lifetime solution, kind of a lot of what we see in Congress today with those that make our laws falling into the same gray area, a 30 second attention span, so nothing ends up getting done.  If we don’t somehow find a way to bridge human values with technology this process of disruption and distraction will only stand to grow larger and levels of frustration and distrust will also grow.  It is what it is.

We just can’t seem to get our priorities straight and instead focus on the next gadget, like an IPAD that distracts and takes center stage, or some new TV show that offers something outrageous to catch our attention.  There’s nothing wrong with this, but should it take center stage when there are real problems that need to be addressed that get kicked back in the corners?   This is that distraction and disruption level I talk about and it’s like a virus that grows every day.  Do we know what real human values are anymore, or do we instead close that door and ride the merry-go-round of embellishing ourselves in a world of disruption? 

I looked at all the web postings about former President Clinton and his heart problems, good grief, a bunch of meaningless chatter.  Everyone appears to want to be the “Shell Answer man” on what he could/should do differently, out shadowing some of the good things he is doing.  You are not going to change people with harsh judgments and it’s better to accept them for who and what they are, and everyone wants a piece of this “control” rhetoric that does nothing but make for a lot of chatter that says and does nothing in reality.  Sure we like to hear about what happened to him and the fact that he is fine and had surgery, but can we take it upon ourselves to leave it at that, don’t think so with everything on the web, flooded with stuff. Harsh judgments seems to be the norm today instead of reaching out to help others, there’s a difference and sometimes all the judgments flat out get in the way of truly helping others. 

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With health insurance this is one big gray area as money efforts cloud this issue every day and we are not sure who’s really there to help and who’s making judgments to save a buck, it’s that 30 second window again with judging perhaps before you have the full story. 

Somewhere along the line we seem to have lost our ability to attain balance on what really matters and until we have enough support and individuals that can create some sort of leadership that sets priorities on how we can create better plans to incorporate this into the fast paced world of technology, human values and what we see as a means for life will continue to diminish, in other words the value of life gets cheaper as the scales of balance continue to erode.  Our President in his own way is looking for this but he’s only one person so it’s up to the rest of us to take a hard look today at what is value, human values and work together and somehow put some balance back into the equation. 

Until such time some of this becomes a reality through effective leadership and role models, we will all continue to live in that 30 Second World of distraction and disruption and sites and people like this will continue with for the most part, lives with little satisfaction and achievement.  BD 

Terri Carlson hopes to tie the knot in order to cash in on her new hubby’s health insurance. And the 45-year-old divorced California mom already has plenty of potential mates ready to put a ring on her finger.

She says she had 1,000 proposals in one week, and she’s still counting.

Carlson, who suffers from C4 complement deficiency, an autoimmune disease that prevents her system from being able to fight infections, is set to join the ranks of the uninsured when her COBRA runs out in May. She says she cannot get health insurance through her job, and takes anywhere from 10 to 20 different prescriptions daily.

And while she has had 7,000 messages in her inbox from all around the globe, not all are from well-insured men who’d like to meet her at the altar.

Half, she says, are from suffering people.

“They have the most heartbreaking stories,” she said. “They’re saying things like, ‘You’re a voice for us’ and ‘Please help us.’ It just breaks my heart.”

Married, with benefits: Calif. mom Terri Carlson starts Will Marry For Health Insurance Web site

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Generic Drugs Yield Higher Profit Margins for Pharmacies Than Name Brands – Patients Save Money Too

2/12/2010 09:47:00 PM    

If you were not aware of this fact you would think it was the opposite, but it’s true, pharmacies make more money from generic drugs.  This year with many drugs imagecoming off patent, this should give additional revenues to drug stores and pharmacies.  So on the brand name drugs, who keeps most of the profit?  1 guess.  Some drugs are also facing competition with medical device solutions too as they are approved by the FDA.  BD

A bunch of the blockbuster drugs that carried the drug industry for the past decade are about to go off patent. As we’ve noted along with everybody else, that’s going to be tough for pharma companies. 

(See, for example, the news this week from Pfizer and Bristol-Myers Squibb, which over the next two years will face generic competition on the two biggest drugs in the world, Lipitor and Plavix.)

CVS, Walgreen to Profit from Generic Drugs - Health Blog - WSJ

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Administration Not Satisfied with Blue Cross Explanation of Recent Rate Increase – Did They Bring the Algorithms?

2/12/2010 08:02:00 PM  , ,  

In reading through this article the information that the administration relied upon was that filed with the SEC, but is this a complete story with enough audit trails to have a true picture?  I’m not saying that carriers didn’t file the information by any means, but does the SEC have enough technology and other related imageinformation to give this a real whack? I say this as the words of Harry Markopoulos still ring through my ears when he declared the information he presented was not understood and they didn’t know what to do with it.  So the question here is was there adequate enough information supplied and has the SEC upgraded their technology where needed so we are not short changed in the information department.   

HHS to California Blue Cross – Bring Your Algorithms to Washington And Explain

Granted they had some expenses with a security breach and also made about 5 million from selling their pharmacy benefit management company in 2009 as far as activities.  This article also states that with less insured, Blue Cross as well as the others made record profits.  It makes you wonder, does the health insurance industry still need me?  I did a post relating to the economy to that effect not too long ago.

“Maybe The Real Problem With The Economy Is That It Doesn't Need You Anymore – Opinion”

There are carriers like United that make more money from their technology today than they do from policies, so again it does make one wonder if humans here too are part of the overall business intelligence profit plan.  The technology side of United, Ingenix just bought another company that does business intelligence software just like they do in 2009.

Ingenix (United HealthCare Subsidiary) to Purchase CareMedic Services – Business Intelligence and Algorithms

Back in August of 2009 I wrote this post with reading about the hundreds of millions invested by United, and not that technology is bad thing by any means, but can you function both as technology and insurer and do it right?

Are You Insured by a Technology or Insurance Company – UnitedHealthCare

We hear from Wendell Potter who worked in the industry for years about how it functions.

Wendell Potter Speaks on PBS with Bill Moyer on Health Insurance Reform – The Industry Did Not Keep Their Word (Video Previews)

Blue Cross has a Venture Capital arm created in 2008.

BlueCross BlueShield Create New Venture Capital Organization

In short in reading every day on the insurance industry in the US I run across a lot of stuff and read about different occurrences all over the US.  As I always say it’s in the algorithms and had a post about that today to hopefully wake some individuals up out of tech denial.  It seems like within the last couple months we are seeing some real aggression here, and I mean outside the “tea parties” which were pretty much just created to house a huge area of distraction so the real business intelligence can continue to work and develop behind the scenes.  If you watched the news with all the coverage, the TEA PARTY DISTRACTION has been pretty successful in doing just that with attracting and playing on the emotions of the ignorant and keeping a constant state of turmoil so rationality has a hard time getting through. 

My next question and perhaps the SEC has adequate records in this area, but what do the reserve pools, or rainy day funds of the carriers look like?  They are required by law to keep reserves and we don’t want to be shortchanged again, so when I start seeing such radical moves as what has happened in the last couple of months, it just makes me wonder.  In addition, do any of the carriers use “reinsurers” and if so that is their status and are they in fact solvent too.

When it comes to solvency we just want to know that we are not going to be stuck in the insurance department again with the likes of AIG who’s reserves were nowhere to be found.  This time though, if we have a mini “Wall Street” fall of health insurance companies fall, there’s a lot more at risk as far as people getting their health needs taken care of too, so this makes one huge case for health insurance companies to be off the market and back to a non profit status.  image

We have seen a small bit of this already with Andrew Cuomo getting the “corrupted” data base created, marketed, and sold by Ingenix for years to be turned over to a new non profit organization to run it.  Pay attention here as this is one big clue we should not over look as more cards fall into the deck and could be a sign of the times.  So again when it comes to information, solvency and non profit status are 2 of my big concerns and if the reserves are shaky, let’s address that now before it could be too late.  Again having the assurance that RESERVES and REINSURERS are financially stable and have liquidity right now is something that should not be overlooked in the scheme of all of this as we don’t know what goes on behind closed doors often enough.  If we can stave off thinking about an IPAD for a few days and keep distraction out of the way and explore this and the SEC having the ability to report all of this, I think we would be miles ahead.  BD  

Anthem Blue Cross, the California health insurance company that was criticized by the Obama administration for raising its premiums, said Thursday that the increases of up to 39 percent were driven by rising health care costs.

But Kathleen Sebelius, the secretary of health and human services, declared the explanation inadequate, especially in light of the profits made by Anthem’s parent company, WellPoint Inc.

“It remains difficult to understand how a company that made $2.7 billion in the last quarter of 2009 alone can justify massive increases that will leave consumers with nothing but bad options,” she said. Those options, she suggested, were to pay more for coverage, cut back on benefits or join the ranks of the uninsured.

The companies are WellPoint, Cigna, UnitedHealth Group Inc., Aetna Inc. and Humana Inc. The data in the report were based on company filings with the Securities and Exchange Commission.

Administration Rejects Health Insurer’s Defense of Huge Rate Increases - NYTimes.com

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Mobile Payments With Square Up –IPhone and Portable Card Reader Reads Credit Cards

2/12/2010 04:16:00 PM  ,  

This is moving into the next phase here and when we talk about doctors making house calls again, what a great way to get payment on the spot.  There’s a similar imagetechnology working for banks to deposit checks with your camera on the phone.  One banks is already there, so are you still just using your cell phone for phone calls?

USAA Bank/Financials Introduce Service for Deposits – Take a Picture of the Check with Your iPhone

Now we finally have a video that shows how this all comes together.  This could easily be done right within the office too and not have to have that card swiping machine around.  Last time I wrote about this company it was just a very small trial in the San Francisco area and it looks like it is growing now. 

You can visit the website here. 

Remember that awesome video that was made for the Twitter iPhone app Birdhouse last year (if not, watch it)? Well, that guy, Adam Lisagor (aka LonelySandwich) is back at it again, this time for the mobile payment startup Square. In the two minute and 18 second video below, Lisagor quickly and easily walks you through what Square is and how to get it up and running.

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Mobile Payment Service Square Simplified On Video

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Health Insurance Coverage Disappears Mysteriously – It’s the Algorithms – He Was Reinstated More Than Likely with Some Human Intervention and Additional Analysis Investigations

2/12/2010 11:55:00 AM  ,  

One more time for all of those still living in or bordering on “tech denial” this is the process that does the dirty work – algorithms to where you and your claims get “scored” and cancellations too can be done on an automated process.  So when you get cancelled from health insurance with a letter sent out, there’s a good chance this was an entirely automated process, it’s the way the formulas work with health insurers.  There’s a real good chance not a human hand touched this case when cancelled; however, to reinstate that process more than likely involved a human to make exceptions and to run further algorithmic formulas to justify the reason for the reinstatement.  Algorithms were even discussed at DAVO this year, they impact our decision making processes all over the place.

Do Algorithms Run Your Life – Bill and Melinda Gates Foundation Commits $10 Billion for Vaccine Research Over the Next 10 Years To Use Them Wisely And Save Lives – Davos 2010

We need to get smart here and really understand how and why this happens.  I spoke recently to an individual that though all claims were reviewed by humans for approval, get a clue, they are not.  I try to bring this awareness around here all the time.  We need to fight algorithms with our own.  Get as much of your own data as you can ready to fight the battle.  

How to Fight Algorithmically “Scored” Health Care Claim Denials – Line Up and Deliver Your Own Data

Algorithms are going further too with predicting your behavior, called “behavioral underwriting”, so don’t miss this one as it is alive and happening. 

Behavioral Underwriting With Biometric Employee Screenings – Red Brick Secures 3 More Clientsimage

You can see news articles all over the web about this process and how it is developing.  It’s all about the data and now biometrics are entering the picture to create even more data for scoring and evaluation purposes.  I like technology but somewhat hold my breath here as we have not quite figured out how to live without disruption with cell phones yet, so add on some additional interactions and go figure?  It can be helpful but at what “potential disruptive” cost?  Implementation is key and we don’t always get that with many start ups having a limited amount of venture capital funding as they need money on the books quickly. 

Wellpoint Enters Contract Agreement with Red Brick for Behavioral Underwriting

Long and short of all this, please read up and know where the processes are coming from so we can all be better educated on how to do battle and are not over run with big business using algorithmic formulas for profits only, some algorithms are good and help develop better healthcare standards too, but we need to know the difference.  BD

The Schaumburg resident, who has multiple sclerosis, takes thousands of dollars' worth of medicine every month.
After he was laid off from Schiller Park-based Wisconsin Tool and Stamping Co. on Jan. 23, 2009, Shaw paid his premiums religiously so he could continue his Blue Cross and Blue Shield insurance through COBRA.
There were some bumps in the road, but throughout his year on COBRA his claims had always been paid.
Until he got a call from his doctor's billing office on Jan. 6. The doctor's office said bills for a series of recent tests, unrelated to his multiple sclerosis, had been denied by his insurance company.
Shaw said he immediately called Blue Cross and was given shocking news. His policy had been canceled, all the way back to Nov. 1.

Shaw said he experienced a similar situation in September, when his coverage was briefly canceled, then reinstated.
"Blue Cross claimed it was canceled by Wisconsin Tool and Stamping," he said. "What the reason for the cancelation was, I am not privy to."

Health insurance disappears, reappears - chicagotribune.com

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IHHI Hospital Bids Continue for the Mortgage –Prem Reddy at 57M and Kali Chaudhuri at 55M

2/11/2010 10:29:00 PM  ,  

The story of this 4 hospital chain has had just about a little bit of everything here and of course money woes and the SEC investigation of their financer just adds icing to the cake.  This is what happened to some of the money:

SEC Investigation Finds Medical Capital Holdings Diverting Investor Funds to Pornography and Other Businesses Aided by Former IHHI President – Orange County

The local Orange County Register has followed this along pretty closely.  Now the people that works there are normal people just trying to run hospitals but have had all of this hanging over their heads since 2007 when it all erupted.  Now there’s a bidding war on who’s going to take over.  Prem Reddy is upping the bid by a couple of million and his lawsuit with the State of California for balance billing is still pending.  Prime hospitals don’t sign contracts with insurers and thus bill at their customary fees.  The two I see here in Orange county no longer are a busy center like they used to be, but they run a good ER, and this appears to be the focus on where the money may be with collecting from insurers.

California sues Prime Healthcare over balance-billing practices

Physicians picketed a few years ago against Chaudhuri taking over the chain of hospitals which was an ugly scene. 

MedCap has about 60 investors in Massachusetts suing as well to get their money back.  About the former CEO trying to cover some of the yacht and porn business:

Former CEO Mogel denied involvement and his own attorney found copies of emails he tried to delete from his computer, well not very smart if you want to hide all evidence with just putting in the recycle bin.  Even so, forensics do a very good job recovering information from computers that have not been wiped of all data through a number of runs.  If you had subscribed to any of the cell phone programs with the women in bikinis and they go away, well I guess you can figure out why.  Overall this is going to be an interesting bid from 2 that have been in out of the healthcare business controversy here in southern California. 

One controversial physician is vying with another controversial physician for the mortgage on Western Medical Center - Santa Ana and three other Orange County hospitals.

Prem Reddy’s Prime Healthcare Services said in a court filing Wednesday that it will bid against Kali P. Chaudhuri for the mortgages on Integrated Healthcare Holdings Inc.  A court-appointed receiver for Tustin-based Medical Capital Holdings is selling the mortgages, which have a face value of $81 million. The sale is scheduled for March 22.

Chaudhuri, the majority shareholder of IHHI, has bid $55 million for the mortgages.

Reddy is offering $57 million.

Reddy objected in a court filing to the bidding terms, saying they favor Chaudhuri. As an “overbidder,” Reddy must deliver a cashier’s check or letter of credit for $57 million while Chaudhuri only has to make a $2 million deposit, according to the motion.

A Chaudhuri-controlled company, KPC Medical Management, collapsed in 2000, disrupting health care for 300,000 Southern California residents. That led state regulators and local physicians to block Chaudhuri’s attempt to take control of IHHI in 2005. But over the past five years he gradually has bought a majority stake.

Reddy owns 12 hospitals, including four in Orange County. In July 2007 the state blocked his attempt to buy Anaheim Memorial Hospital. A year later, the state sued Prime Healthcare for billing patients for costs not fully paid by their insurers. That lawsuit is pending.

MedCap financed IHHI’s 2005 purchase of WestMed -Santa Ana and three other hospitals — Western Medical Center - Anaheim, Coastal Communities Hospital in Santa Ana and Chapman Medical Center in Orange. The four hospitals together have 12 percent of the county’s hospital beds and serve many of the county’s poorest residents.

The Securities and Exchange Commission sued MedCap for fraud last summer. Receiver Thomas A. Seaman took control of MedCap’s assets in August and is trying to sell them off. MedCap investors are owed more than $1 billion, Seaman has reported.

The Securities and Exchange Commission sued MedCap for fraud in July 2009. A court-appointed receiver subsequently reported that most of the accounts receivable on MedCap’s books — billings with a face value of $543 million — did not exist.

New bidder emerges for MedCap hospital loans - OC Business News : The Orange County Register

Related Reading:

Medical Capital Holdings Closed by Federal Judge – IHHI Hospitals Waiting Outcome
IHHI Hospital exec framed doctor on gun charge, lawsuit says – Orange County CA
IHHI Announces Completion of Re-Financing - Orange County, CA
Doctors sue hospital firm IHHI
Chaudhuri buys stake in IHHI Hospital Group
Larry Anderson quits as president of hospital owner IHHI - Orange County, CA

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Goldman Sachs – Former Programmer Gets Indicted for Stolen Code – AKA Intellectual Property

2/11/2010 09:02:00 PM  , ,  

Being I used to write code, this story interests me and it’s happening all over the world with the “smart” people running algorithmic formulas to make money and take from those who do not.  I just did a post about this topic today with United Healthcare and their algorithmic formulas.  This is one of the reason I plaster that word along with a link to the definition in the middle of this blog with hopes of bringing about an awareness and bring some out of “tech denial” so they understand what processes are working either for or against them.  The folks at the hospital, peer groups, etc. were entirely befuddled.  When you create algorithmic formulas with code that is complex and intricate, the average person has no clue and health insurance has been doing this for a long time.   Health insurance carriers and Wall Street are two of the heaviest investors in technology, to have the best designed code and hardware – High Frequency Healthcare.

Hospitalists, Peer Committees and Utilization Struggle to Comprehend United HealthCare Algorithms

Computer code is so modular today and thus there are a number of modules that go into making a program work.  In the past with the size of the files reported I find it hard to believe that there was enough to simulate their code machines at Goldman, but there could have been enough to build from for a new program.  What do you think Dot Net is with Microsoft?  The code has to go somewhere and the basics are there and additional code is written on top to develop from.  This way we are not building everything from scratch as it would never gone done.  I used to use other people’s modules and incorporate them into the entire scheme after some modifications.  Again, I am basing this from what I have read and I personally think this is going to be one touch case.  First of all you need a jury that knows what “code” is and how it works, otherwise half of the entire court case is way over their heads and they won’t understand. 

Goldman Stolen Code – Has Algorithmic Fraud Become A Business Model in HealthCare Too?

What did AIG have to say back in 1987?

AIG: You Bring the Nerds and the Algorithms and I’ll give you a AAA Rating…a little history from 1987

Goldman has the latest version of the Inslaw/PTECH/PROMS software and front run the market including their own clients, that's how they get their money through software with accelerated business intelligence algorithm and aggregation capabilities.

Ex-Goldman programmer Inquisition Continues – Did He Really Steal the Algorithms or Just Worked on Code from Home?

At any rate this will be an interesting show to see how it all plays out and one thing that came out of this was the admittance of Goldman on of how important and how much money those algorithms make for them.   Health Insurers are looking for new algorithms all the time.  When you have health insurers that are tied in close to Wall Street, there might be some algorithmic aid in here somewhere too. 

How Similar is Wall Street to the Health Insurance Businessimage

Some of the links above go back to a year or longer, so I have been watching this for a while and again it is my intention to somehow drag folks out of tech denial and explain that this is how they make money, it’s all about the algorithms being used against the ignorant, you and I for that matter.  This is also a big part why the White House has such a strong emphasis on getting the government up to date.  Our last administration was heavy in “tech denial” and there was no sense of urgency, but big business saw it differently and went to work on their algorithms as they knew the return would be good, and look at where they are today.  They even preach this to others as solutions, but carefully not to wake up the tech denial world as that is what affords their freedom.  They got spoiled with 8 years of this type of operation and now it’s changing. 

Health Care Insurers Suggest Algorithms and Business Intelligence solutions to provide health insurance solution

The man being prosecuted is smart by all means, smarter probably than everyone else in on the case from both sides so again this will be interesting to see if an intelligent trial is conducted or if it ends up being the same old horse and buggy stuff with all the drama kings and queens.  BD 

Federal prosecutors said Thursday that Sergey Aleynikov, a former computer programmer at Goldman Sachs, had been indicted on charges that he stole proprietary software that the firm uses to make rapid-fire trades in the financial markets.

The indictment accuses Mr. Aleynikov of theft of trade secrets, transporting stolen property in foreign commerce and unauthorized computer access. If convicted of the charges, Mr. Aleynikov would face up to 25 years in prison, the United States Attorney’s Office in Manhattan said.

Programmer Indicted in Goldman Code Theft Case - DealBook Blog - NYTimes.com

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Former President Bill Clinton Gets A New Stent – Interventional Heart Repair

2/11/2010 08:22:00 PM  ,  

From writing this blog I probably ended up knowing more about stents that I ever thought I would need to know and interventional procedures.  According to this video one stent needed to be replaced, as sometimes they can move, jar loose and collapse.  image

Know your stent!  Now everybody is going to laugh at that statement but there’s good reason for it, ask your doctor about the type of stent you are going to receive and what to expect.  Mr. Clinton also had a quadruple by pass a few years ago too, so he has gone the gambit with heart surgery to say the least.  Below is why you may want to ask about what type of stent you would be implanted with.  They are not all the same. 

Whistleblower Off Label Marketing Law Suit – Stents Marketed and Implanted To Treat Blocked Blood Vessels But Were Made To Be Implanted in the Digestive Tract To Treat Cancer

How common is this type of procedure, very.  El Camino Hospital has 5 surgery rooms dedicated to interventional surgery.  The link has a video to learn more. 

In most instances with interventional procedures the patient can be up and around in a very short time.  The catheter goes up through a vein in your groin and the 3D imaging for accuracy just within the last year has improved tremendously.  I learned quit a bit in talking with Dr. Bart Muhs from Yale Medical Center.  He told me that sometimes he does full open heart surgery and other times his procedures can be done interventionally with aortic procedures.  With a full open heart surgery you are basically done once healed.  Not so with a stent, you need to return back to your doctor for check ups. 

Interview with Bart E. Muhs, M.D., Yale School of Medicine – Aneurysm Repair Surgery

The stent business has even gone beyond the cardio area and stents are now placed in legs for people who suffer with PAD.  Did you know there is a test that can be done before any surgical procedure to check your body for blood clots?  Sounds like a good one to me, but all physicians may not perform this test, ask for it.  The folks at Cook Medical educated me to that fact during an interview last year relative to stents for PAD.  Almost in any cath lab you will find their Vena Cava stents all over the US.  When you are putting a stent in a leg it has to be tough and durable as legs move, versus a heart that is by comparison stationary. 

Cook Medical Interview Discussing PAD Leg Therapies– Rob Lyles, VP Peripheral Intervention Division

One other note worth a mention is that you also want a drug eluding stent as those are seeing a lot more success without having additional infections or rejection by the body.  They have a drug that is used for cancer that lasts for about 6 months or so to help the body during recovery .  BD

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FDA Just Changed Warfarin Label – There’s A Device For Those With Atrial Fibrillation that Can Replace the Drug

2/11/2010 07:48:00 PM  ,  

As is indicated again the Warfarin dosing for blood thinning label has changed.  Perhaps the future is an implanted device?  Last year I did a post about the Watchman and a year later there are actually 5 people walking around with a Watchman implanted in the UK.  This was also a set back for the pharmacogenomic test with Medicare deciding not to pay.  Here we are back to money.  Last year I can’t count the number of stories on Warfarin. 

Medicare has Decided Against paying for the Genetic Warfarin Test For Now

This was the post from last year at about this time. 

Atrial Fibrillation – What will be the future standard of care, Warfarin or the Watchman Device?

This requires an interventional procedure.  After the device is put into place, additional measurements and pictures will be taken to make sure the device is in the correct position. Once your doctor has confirmed the position, s/he will release the device to leave it permanently implanted in your heart.  The device may not be the answer for all, and we will still need drug blood thinners outside of AF, but it does represent a potential winner for those affected with Atrial fibrillation that take blood thinners.

In the UK all patients who have AF and are prescribed warfarin are eligible for the implant on the NHS an you know we won’t get anywhere near that deal here.  It has not been approved by the FDA here in the US yet.  Again, this is potential good news for many, but for the other side of the coin, the genomic testing for the drug seems to be up in the air and getting more complicated by the day as far as what is an appropriate dose for one of the most difficult drugs to monitor.   BD 

image

“The changes in 2007 suggesting pharmacogenomic testing didn't go far enough, evidently, so now, with pretty minimal evidence, FDA has gone ahead and upped the ante with specific recommendations for starting doses depending on the VKORC polymorphism profile. They cite "multiple studies" to justify a dosing table (!), which is news to me. The only evidence that exists, as far as I know, is a 2009 clinical trial that showed patients stayed within a therapeutic INR for more time when pharmacogenomic dosing was used. There was no difference in bleeding or thrombosis in that study, meaning that clinical outcomes were not improved by the pharmacogenomic testing.”

image

FYI: FDA just changed warfarin label--again! | interactmd.com

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UCLA – Histone Modifications Can Be Used to Predict Outcome and Treatment With Pancreas Cancer – Personalized Medicine

2/11/2010 03:11:00 PM  ,  

This is a beginning groundwork for a commercial test.  This could also lead to tests for other types of cancer, such as prostate and kidney cancer.  This is similar to the breast cancer study for inherited genes in short.  Pancreas cancer is so deadly and with having information up front relative to DNA findings, perhaps this might give some different treatment directions as the the title here suggests.  BD 

Press Release:

Specific chemical modifications to proteins called histones, which are found in the nucleus of cells and act as spools around which DNA is wound, can be used to imagepredict prognosis and response to treatment in subsets patients with pancreatic cancer, a study by researchers at UCLA’s Jonsson Comprehensive Cancer Center has found.

High levels of two specific histone modifications in tumor cells of patients who underwent surgical resection of their pancreatic cancer predicted those patients more likely to derive survival benefit from the commonly used chemotherapy drug Fluorouracil, or 5-FU. Along with Gemcitabine, 5-FU is a common chemotherapy used to treat patients with pancreatic cancer, the fourth deadliest cancer in the United States.

“These histone modifications were useful in predicting whether or not a patient was likely to respond favorably to 5-FU” said Dr. David Dawson, an assistant professor of pathology and laboratory medicine, senior author of the study and a Jonsson Cancer Center researcher. “Using a specially devised test and algorithm, we were able to discriminate two groups of pancreatic cancer patients who were more or less likely to have longer disease-free remissions and overall survival.”

The histone modifications themselves also may prove to be future targets for drug therapies, Dawson said.

The study, which needs to be validated in a prospective study, was published this week in the peer-reviewed Journal of Clinical Oncology.

Jonsson Cancer Center researchers, led by Dr. Siavash Kurdistani and Dr. David Seligson, developed and patented the immunohistochemistry assay, or antibody test, to measure the levels of the specific histone modifications within cells. The rights to that technology have been licensed by an outside company.

Kurdistani and Seligson, also authors on the study, previously used the test to identify the same histone modifications in subsets of patients with prostate, kidney and lung cancers. They showed that low cellular levels of the histones could determine which prostate cancer patients were more likely to suffer a recurrence and which patients with lung and kidney cancers would experience poorer survival rates.

The current study centered on a field known as epigenetics, which focuses on inherited information other than that directly encoded by DNA. In addition to genetic mutations, epigenetic changes such as alterations to histone modifications contribute to the development of cancer, said Kurdistani, an assistant professor of biological chemistry.

“Overall, these histone modifications are providing useful information as to how a cancer may behave,” he said. “In addition, there may be a direct causal link between these changes and tumor aggressiveness.”

The tissues used in the study came from a 195- patient cohort enrolled in the Radiation Therapy Oncology Group 9704 trial, a multi-center, phase III study of pancreatic cancer comparing adjuvant Gemcitabine with 5-FU, and a separate, 140-patient cohort of patients with stage I or II pancreatic cancer from UCLA.

Generally, low levels of histone modifications were found to be predictors of poor survival in both patient cohorts, and to identify those less likely to respond to 5-FU in the 9704 patient cohort, the study reports.

“Pancreatic cancer is a highly aggressive and lethal cancer for which there are limited therapeutic options,” the study states. “Along with genetic events, tumor-imageassociated epigenetic alterations are important determinants in the initiation and progress of pancreatic cancer and represent promising biomarkers and therapeutic targets.”

It may take three to five years to develop a commercially available test that could be used on prostate, kidney, lung and pancreatic cancer patients, Kurdistani said.

Next, Kurdistani and Dawson will be pursuing studies in cell lines and animal models to determine what if any role the histone modifications have in causing the development of aggressive forms of pancreatic cancer.

“If you can uncover the mechanism of how the histone modifications are associated with cancer development and/or progression, you may be able to design strategies to interfere with that process,” Kurdistani said. “Such a strategy could be the basis for a targeted therapy or chemoprevention approach.”

Kurdistani said the current study could not have been done if not for the collaborative and multi-disciplinary research within the Jonsson Cancer Center and UCLA. The study was funded through grants from the National Institute of Diabetes and Digestive and Kidney Diseases, the Radiation Therapy Oncology Group Translational Research Program, the California Institute of Regenerative Medicine and the Hirshberg Foundation for Pancreatic Cancer Research.

UCLA's Jonsson Comprehensive Cancer Center has more than 240 researchers and clinicians engaged in disease research, prevention, detection, control, treatment and education. One of the nation's largest comprehensive cancer centers, the Jonsson center is dedicated to promoting research and translating basic science into leading-edge clinical studies. In July 2009, the Jonsson Cancer Center was named among the top 12 cancer centers nationwide by U.S. News & World Report, a ranking it has held for 10 consecutive years. For more information on the Jonsson Cancer Center, visit our website at http://www.cancer.ucla.edu.

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Remote Area Medical Making An Unprecedented 2nd Clinic Appearance in the Los Angeles Area April 27-May 3, 2010

2/11/2010 11:24:00 AM  ,  

We all remember last year when Remote Area Medical was able to provide free medical care to over 5,000 individuals at the Los Angeles Forum.  They are coming back imagefor a second helping hand.  This time not at the Forum but at the Los Angeles Sports Arena.  They are looking for volunteers now and the information is included below.  Also I made up the widget you see below that can be copied and added to any website that has their RAMLosAngeles updates as they post them.  I also have the widget on this blog for reference, so it’s a good think I kept it going as we will be getting more updates.  Right now RAM is in Haiti and flew in their DC 3 with supplies and personnel to help the earthquake victims. 

What is interesting here too is that this appeared on the LA Care website that helps find “free” or low cost health insurance plans for residents of Los Angeles County.  You can also visit the Remote Area Medical Website and see what is on the agenda for 2010 for additional clinics that have been scheduled.  Hat’s off to their fine efforts in Haiti, we appreciate their efforts in helping the healthcare crisis we have on our own home grounds. 


This is me thinking out loud here, but recently we saw the birth of a new television show with the CEO of Waste Management learning about the human side of life through walking in other people’s shoes and seeing what they experience.  Something along those lines with participating and experiencing what individuals do in the US who are struggling by attending one of these events “undercover” would certainly serve to open many eyes. 

Until someone visibly sees what is happening and has some experience by perhaps walking in another's shoes,  it just doesn’t seem to get the attention and urgency it needs, and healthcare reform is very urgent right now in the US.  If we don’t all work together is will break the country as we don’t have the same alternatives we had years ago, those ideals are gone.  BD   

We need your help! RAM-LA needs doctors, nurses, dentists, hygienists, optometrists and nonmedical volunteers to help provide FREE medical, dental and vision care to thousands of LA County residents. Sign up now if you're interested in volunteering, or if you'd like to learn more about how you can help out at the next RAM-LA clinic.

L.A. Care Health Plan is a community-accountable health plan that serves nearly 800,000 Los Angeles County residents through four free or low-cost health insurance programs: Medi-Cal, Healthy Families, L.A. Care’s Healthy Kids and L.A. Care Health Plan Medicare Advantage HMO.

Our members have access to more than 10,000 providers — including doctors, specialists, hospitals and pharmacies — close to their homes, work, and schools.

Location:

L.A. Sports Arena
3939 North Figueroa Street
Los Angeles, California, 90031

Sign Up to Volunteer

Please contact RAM-LA at ramusa09@gmail.com if you have any questions about this event.

L.A. Care Health Plan

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Hospitalists, Peer Committees and Utilization Struggle to Comprehend United HealthCare Algorithms

2/11/2010 09:45:00 AM  ,  

First of all hats off to the Happy Hospitalist for having the “guts” to discuss this matter and he’s not alone by any means.  This is happening all over the country.  Are we getting to the point to where we will need to have an attorney on a retainer available in order to get admitted to the hospital when we are sick and need care?  When you read his accounting it will certainly put that question in the back of your head.

The average person has no clue on how complicated “coding” is these days, in other words the codes that are entered for reimbursement and we are splitting hairs today with complicated formulas or algorithms to provide payment.  This sucks when a patient needs care and you have a doctor wanting to provide care. 

To further complicate the matter, the review committees appear to be in the dark as well.  In this situation you have a doctor giving good care, keeping hospital stays down or out of the picture when not required in his estimation, which it doesn’t take a brain surgeon to figure out that if a patient is not admitted, one saves money.  Now add to the situation that many hospitals are looking for more revenue as 55% of our US hospitals are operating in the red, see what I mean, it gets complicated.  The Texas Medical Association did a video last year that explains some of what happens.  You can watch the video below and read the entire post at the link below.

Hospital Admissions are Down – ER Doctors are Fired – Texas Medical Association

In his case here, we have an active discussion over what is observation (and how it is coded) versus being admitted as an inpatient (and how it is coded).  Reimbursement rates vary for each scenario, so it falls back to a committee, who is also confused on how all of this works.  Contracts change with insurance carriers too.  As Happy mentions, he and his coding people keep seeing claims denied, day in and day out.  We all know what happens when claims are denied, nobody gets paid and some of this rolls back to the patient, doctors, hospital to make it up, everybody loses.

In his case he mentions the 48 hour time level where this factor seems to be critical for reimbursement, so what do you do here, make sure everyone stays longer than 48 hours?  He asks the question about the 48 hours and a physician reviewer would take a look and evaluate the chart and would “overturn” the observation status (coding) he states, but look at what we have done here, now we have a process that takes time for another person to evaluate and hopefully they claims are paid and overturned, but this adds more time if nothing else to the processing area.

He brings up a good point that has been discussed before, why do hospitals get punished for providing good healthcare? In other words many hospitals have their own quality programs and it seems to hit head on with the algorithmic formulas presented by some insurers, long and short of this, more red tape.   Happy is practicing “hospital medicine” and is very aware of how to help the patient with medications when he discharges a patient and in another post references how he picks generics that he knows the patient will fill versus one that is too expensive and will go unfilled.  He also notes that some patients end up back at the hospital as they can’t afford those medications, so now we look at re-admission. 

Back on track here, this is a managed care Medicaid program which is pretty much the lowest reimbursement rate around in most states, I know it is here in California.  Also in the news this week United created some confusion in Connecticut with the assumption of the HealthNet patients they are acquiring.  It does make you wonder are they in fact maybe overwhelmed with their own data systems and maybe a little over analyzed?  What ever happened to the MIB (Medical Insurance Bureau)where carriers shared and were able to look at insurance provided for individuals so they would have some history? 

Connecticut State Medical Society Demands that United Healthcare/Ingenix Stop The Requests For Patient Records

The care you get may not come down to a code, but reimbursement sure does.  We talk about patient advocates being needed to get care, but again this looks like it has the settings for a legal interpretation just to get care at the hospital.  As a patient, your claims are “scored” and when things fall outside of the automated process the battles begin as then committees, advocates, etc. have to stop everything and get down to the details of every single item involved. image

How to Fight Algorithmically “Scored” Health Care Claim Denials – Line Up and Deliver Your Own Data

The doctors are just trying to get the patient the care they need while following procedures and standards and if a work around for coding somehow appears, then later on these can be subject to queries ran by risk management that could isolate such claims as having potential fraud characteristics as determined by the business intelligence rich algorithmic codes devises to detect “potential” fraud with setting the parameters to report on the desired areas they feel are out of compliance.  That’s the way SQL statement and queries work, have written a number of queries myself for analytical data in order to provide decision making numbers, all businesses do this, it is an everyday practice with business. 

Little Progress on Fighting Healthcare Fraud – Look At Who’s Getting the Anti-Fraud Contracts

We have so many legal suits going on over healthcare coverage and it is creating battles that should not be there.  There is also a role to be played here with the drug manufacturers too with making medications affordable.  I don’t have a problem with recovering R and D costs, but those margins are not what they have been in the past either so the high prices charged and out of consumer reach are not helping matters at all and yet we keep throwing millions of dollars at companies without having any idea if there will be a return on investment.  Big pharma has curtailed some of their own activity here with either shipping it over seas or using a VC funded biotech to develop and then when trials are looking good, they may come in and either invest or buy the company. 

Insurance Companies Under Attack with Lawsuits – Generated by Their Algorithms

In the meantime the algorithmic formulas of risk management prevail and it is putting doctors in a very uncomfortable position and creating reviews, utilization reviews to over ride, substantiate or what ever the case is to determine whether or not a claim gets paid.  Out of network claims for 8-9 years were both under paid for MDs and patients and those lawsuits keep piling up too. 

“Fair Database” to Replace Unfair Ingenix Data Base – Run by Non Profit

This is just one story out of many, but it is a prime example of what is happening at the point of service today and again how much more complicated can this get?  Are we on our way to further refinements where legal counsel will be required to be admitted?  Somebody has to sort all of this out and that is the way our court systems are set up, so what’s the next level here?  Will having a legal degree along with a medical degree become the next “normal” in order to practice medicine and take care of patients?  Of course I am saying this with a bit of sarcasm as the education costs for doctors would mount tremendously and with compensation the way it is today, most individuals would look for an alternative route for income that is not so complicated I think and add to the already mounting shortage of doctors we are starting to see. 

“Department of Algorithms – Do We Need One of These to Regulate Upcoming Laws?

I said this about 2 years ago, we just might need to start filing these algorithms digitally and have a Congress and their staff that can begin to comprehend what is happening here as technology and algorithmic formulas will continue to complicate every area of payment we have, including healthcare.  Ask any broker on Wall Street how they made the big bucks, “it’s all in the algos” and look at Goldman Sachs for the prime example of software algorithms at their best making profits.  BD

When I got off the phone, I had just one question floating in my mind:  Is United Health Care's Managed Medicaid contract and physician review process a scam?  I found myself with many unanswered questions.  Here's how that went down.

I recently admitted a patient with an illness requiring an acute inpatient hospitalization. According to my utilization review folks, my patient met both the intensity of services requirement AND the diagnosis requirements necessary to meet inpatient criteria.  You see, in  order to qualify for hospital admission  the patient must meet very specific criteria published in a thousand page book that defines what diagnosis must be present and what hospital services must be provided to qualify for an inpatient hospital stay.

You can't simply drop grandma off at the ER and demand admission because you're tired of taking care of her.  That's what a nursing home is for.  I am not a nursing home doctor. I am a hospital doctor.  A hospitalist.  That's why I put up a brick wall for social admits whenever it is humanly possible.  Because a hospital is not the appropriate place for a nursing home patient.  The nursing home is.

Physician Review Scam? My Experience With United Health Care's Managed Medicaid Physician Review Process

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