Who Says a Colon Exploration Should Take Two Hours?

Leave a reply

The Washington Post has a story on the 'secretive panel' of doctors who come up with the pricing on all medical procedures:

Unknown to most, a single committee of the AMA, the chief lobbying group for physicians, meets confidentially every year to come up with values for most of the services a doctor performs.

Those values are required under federal law to be based on the time and intensity of the procedures. The values, in turn, determine what Medicare and most private insurers pay doctors.

But the AMA’s estimates of the time involved in many procedures are exaggerated, sometimes by as much as 100 percent, according to an analysis of doctors’ time, as well as interviews and reviews of medical journals.

If the time estimates are to be believed, some doctors would have to be averaging more than 24 hours a day to perform all of the procedures that they are reporting. This volume of work does not mean these doctors are doing anything wrong. They are just getting paid at the rates set by the government, under the guidance of the AMA.

So, who's surprised by this? And it gets better:

To determine how long a procedure takes, the AMA relies on surveys of doctors conducted by the associations representing specialists and primary care physicians. The doctors who fill out the surveys are informed that the reason for the survey is to set pay. Increasingly, the survey estimates have been found so improbable that the AMA has had to significantly lower them, according to federal documents…

In the late 1980s and early ’90s, the United States called on a group at Harvard University to develop a more deliberate system for paying doctors.

What they came up with, basically, is the current point system. Every procedure is assigned a number of points — called “relative value units” — based on the work involved, the staff and supplies, and a smaller portion for malpractice insurance…

This point system is critical in U.S. health-care economics because it doesn’t just rule Medicare payments. Roughly four out of five insurance companies use the point system for the basis of their own physician fees, according to the AMA. The private insurers typically pay somewhat more per point than does Medicare.

Once the system developed by the Harvard researchers was initiated, however, the Medicare system faced a critical problem: As medicine evolved, the point system had to be updated. Who could do that?

The AMA offered to do the work for free.

Has no one heard of the fox in the hen house? Sheesh. It's one thing for the doctors' groups to be consulted – they should be – but to drive the entire process? That's absurd.

Race as a Distraction

Leave a reply

In college, way back in the dark ages of the 1980s, I had a roommate from Scotland who was intrigued with the racial discord he observed in America. To him it made no sense that people would hate each other based on their race, but of course it made total sense to him that the Catholics and Protestants back in Scotland were in a constant state of discord. He'd say, and I'm paraphrasing here, "Why do you Americans hate each other for what you are? At least in Scotland we hate each other for what we choose to believe."

Whenever race comes up as a topic I think about those words. Indeed, it's totally illogical for us to hate one another for something we have no control over. In fact it's probably the most absurd reason for people to hate and distrust each other. On the other hand, probably the most logical reason for any group of people to dislike another is if one group has disproportionately more of anything – wealth, food, opportunity, etc. – than the other, particularly if the group with less feels that the other group has gotten it off of their backs.

That's why the new data about the true nature of poverty in America, and the plight of working class whites in particular, should scare the bejeezus out of this country's power structure. Once all of the poor and struggling working class folks from every race realize they have more in common with each other than with the wealthy of their own race they will form a formidable body to deal with. From the article linked above:

As nonwhites approach a numerical majority in the U.S., one question is how public programs to lift the disadvantaged should be best focused — on the affirmative action that historically has tried to eliminate the racial barriers seen as the major impediment to economic equality, or simply on improving socioeconomic status for all, regardless of race.

Hardship is particularly growing among whites, based on several measures. Pessimism among that racial group about their families' economic futures has climbed to the highest point since at least 1987. In the most recent AP-GfK poll, 63 percent of whites called the economy "poor."…

While racial and ethnic minorities are more likely to live in poverty, race disparities in the poverty rate have narrowed substantially since the 1970s, census data show. Economic insecurity among whites also is more pervasive than is shown in the government's poverty data, engulfing more than 76 percent of white adults by the time they turn 60, according to a new economic gauge being published next year by the Oxford University Press.

There's another important societal component contributing to the economic struggle of millions of individuals in this country, and it's one we need to deal with head on: the breakdown of the traditional family. Again from the article:

–For the first time since 1975, the number of white single-mother households living in poverty with children surpassed or equaled black ones in the past decade, spurred by job losses and faster rates of out-of-wedlock births among whites. White single-mother families in poverty stood at nearly 1.5 million in 2011, comparable to the number for blacks. Hispanic single-mother families in poverty trailed at 1.2 million…

Marriage rates are in decline across all races, and the number of white mother-headed households living in poverty has risen to the level of black ones.

As a man who has been happily married for a long time I'm obviously a fan of the family structure. However, whenever the topic of single parent homes comes up for public debate we get pulled into the moral/religious rabbit hole and never address the economics of single parenthood. Why do we insist on approaching this problem from a moral standpoint, haranguing young men and women about their sinfulness and almost guaranteeing they'll tune us out, and not instead concentrate on developing societal structures that will help deal with a very real problem? I'm not smart enough to have a solution here, but it doesn't take a rocket science to realize that the answer is not browbeating people back into church and insisting that they live they way great-Grandma and Grandpa did. 

Our leaders, whether in industry or government, need to begin to deal with the reality that is portrayed in this new data or our country will soon be in even deeper doo-doo. They can no longer hide from the reality that our middle class is disappearing and that our "land of opportunity" could quickly become an empty slogan if they don't change things, and fast.

Uber Teens

2 Replies

Uber is a service that allows you to use an app on your smartphone to book a ride with a car service. Right now the service is available in several large cities around the country so it's not currently relevant here in small-city North Carolina, but the reason it hit my radar is a blog post a mom wrote about why she signed her teenage daughter up for the service. An excerpt:

When I met the Push Girls last year I noted that four of the five women I met were in wheelchairs because of car accidents. The accidents were all excessive speed or alcohol fueled. If a smart phone app can get my child home without risking dangerous driving conditions I’d be a fool to not use it.

Parents of teens: I’m going to ask you to do something we should all do at least once a day. I want you to be still and quiet and try to remember being 14 or even 17. Now put yourself at your friend’s house and their parents have just left. All of a sudden 5 other kids appear and they’re thinking about drinking a beer and smoking some pot. What does the 14 year old you do?

The only answer I have is that I know the 14 year old you doesn’t call Mommy for a ride home.

Now imagine the same scenario. The 14 year old you pulls out a smart phone (it’s probably already out) and texts for a town car. 14 year old you can hop into the back seat of a limo and get home. My credit card information is already stored in the app, no money changes hands and your private driver gets you home.

Boom. Done. Decision made.

That logic is pretty sound to me. In our household we have a similar rule in that any of our kids can call us for a ride and not risk getting in trouble. Sure we'll have a talk about it the next day and we'll push to make sure they avoid getting themselves in similar situations in the future, but I'd rather get a 12:30 a.m. phone call asking for a ride than risk having them hop in a car with an inexperienced driver who may or may not be inebriated. Still, how many kids actually believe their parents won't come down on them like a ton of bricks if they call for a ride in the middle of the night? Not many, which is why I like the idea of a kid having a tool at their disposal that can help them do the right thing.

There's another part of the blog post that was really horrifying to me as a father and it's about teen girls dealing with other dads who play grab-ass:

Then Laurie and I started talking about why every kid should have Uber on their phone and when we got to the part about being a teenager and on occasion not wanting to get into a car with a Dad who plays grab-ass the new Dad looked at us with horror in his eyes. Even though 100% of the adult women at the party sort of nodded and knew what that felt like I was all, “Oh but times have changed. I’m sure it will never be an issue.”

For the record it's my opinion that while having a service like Uber to get my daughter out of harm's way at that moment would be a good thing, it would also be of utmost importance that she inform me of the offending father's actions and allow me to use another tool at my service: a large can of whoop-ass.

It’s a Start

Leave a reply

In the past I've written extensively about how frustrating our health care and health insurance systems are in the good ol' US of A.  As I see it one of the biggest obstacles to true health care reform in this country is the lack of transparency in the system, or in laymen's terms, the fact that you generally have no idea how bad you're screwed until well after you've received whatever treatment or service for which you visited the doctor.

That's why I was very interested in this piece at the Triad Business Journal's blog:

Passed last week in the waning days of this year's legislative session, the "Health Care Cost Reduction and Transparency Act of 2013" (House Bill 834) will create an online database of what hospitals are paid, on average, for the 100 treatments they perform most frequently. They'll also be reporting their costs for the 20 most common surgical procedures and 20 most common imaging procedures.

Take a case of pneumonia. N.C. consumers will now be able to go online and compare a variety of prices for that treatment. The database will tell them what Medicare pays for the treatment of pneumonia, what Medicaid pays and the average of what the five largest insurers in the state would pay the hospital.

Additionally, the database will offer up what the charge will be for a person with no insurance, and what the average price that the uninsured are able to negotiate with the hospital to pay.

That's a lot more info than is now available to N.C. consumers, though a clearer picture of what health care costs are in the state is still emerging.

This is what NC's attorney general had to say:

N.C. Attorney General Roy Cooper, who had advocated for several of the provisions included in the final transparency law,praised its passage.

“We recommend that consumers shop around for a good deal, but our health care system doesn’t make that easy to do,” Cooper said. “Giving consumers straightforward information on what medical services cost and what they owe will help them make better decisions about their health care.”

He's got that right, especially when you're talking about preventive or non-urgent care. Obviously if you're in an emergency situation the last thing you're going to think about is whether or not the hospital nearest to you is the cheapest, but when a consumer has time to think having accurate information is the most valuable tool at his disposal. 

What I hope we see in the very near future is an app on our phones that will be linked to a database of ALL medical procedures from all health systems. And while I'm dreaming I'd love to see our state have more viable health insurance options than the duopoly we currently "enjoy" in North Carolina.

Google (Re)Discovers the 19th Century

Leave a reply

An article over at the Chronicle of Higher Education looks at an interesting effect of Google's book digitization program:

Google Books is a kind of Victorian portal that takes me into a mare magnum of out-of-print authors, many of whom helped launch disciplines. Or who wrote essays, novels, and histories that did not transcend their time. Or who anonymously produced the paperwork of emerging bureaucracies, organizations, and businesses that, because printed, has been scanned and, because scanned, is now available.

I am not a scholar of the 19th century but have found its digitization to be one of the most fascinating new resource for understanding the centuries that precede it.

It is not by chance that the 19th century gave birth to projects such as the Oxford English Dictionary. The OED is the tip of an iceberg of genteel scholars, male and female, who had the time and resources to dig through vast mounds of material and make something of it. Those researchers lived in closer chronological proximity to their subjects than we do; they often worked amid the dimly lit bookshelves and attics of private homes. As a result, their experience of a historical subject captures a sense of intimacy that might otherwise be lost.

 

In Retrospect

Leave a reply

Over at Letters of Note is a great letter written in 1974 by an WWII veteran and pilot on his deathbed to his grandson:

But, in spite of what I've said, there is much, in life to enjoy – to relish. There is also much that can be done to make life worth while and living worth the "candle." There is a rich heritage of literature and music that awaits your investigation – it's there for the taking – in the libraries of the country and in the archives of the museums. There is poetry and prose – enough to fill all the hours you can spare to listen to them and more knowledge, on every conceivable subject, than you can assimilate in a lifetime. It's all there just waiting for you to ask for it or to seek it out. Don't overlook it or pass it up for less important or less meaningful pastimes.

Most important of all is ability to savor life, to taste of it in as many variances as you can – while you can. Life never looks so short as when you look back on it. Unfortunately you cannot do this until it has passed you by. So, as you go through life, don't overlook the "Lily in the Field," the newborn puppy, the fledgling bird – for they are as much (or more) of life as the tall buildings, the shiny automobiles and the possessions we tend to place so much importance upon. If you can do just this much – life will be more meaningful for you…

And my favorite paragraph, one that I would echo for my own children:

If I could package (with ribbon) those gifts that I would most like to give you, I would. But how do you package integrity, how do you wrap honesty, what kind of paper for a sense of humor, what ribbon for inquisitiveness?

Library of the Future? 3D Printing, Books on Demand, Oh My!

Leave a reply

The Washington Post has an article about DC's Martin Luther King Jr. Memorial Library that shows a glimpse of many public libraries' future:

…D.C. Public Library system, which today is opening theDigital Commons at the Martin Luther King Jr. Memorial Library. The new facility, in a renovated 11,000-square foot section of the library's ground floor, contains a 3-D printer, an Espresso Book Machine that churns out tomes on-demand, an array of tablet devices, rows of computer terminals, and several meeting spaces outfitted with some of the newest productivity technology…

Next to the 3-D printer is a countertop full of tablet computers and ebook readers, devices on which DCPL finds an increasing percentage of its membership. Every major brand is represented—Apple, Samsung, Amazon, Barnes & Noble, Microsoft—in what Cooper bills as something of a test counter. More and more, library members are loaning volumes on their devices rather using software like Overdrive for books or Zinio for periodicals. (Cooper says over 5,000 library members are using Zinio for public magazine subscriptions; the most popular title is The Economist.)…

Then there is the Espresso Book Machine. Printing books or magazines is not an inexpensive venture, but for the hopeful self-publisher, or someone desperate to obtain a tactile version of an out-of-print volume (sorry,Dream City won't enter the public domain for many more decades), this small press is an affordable solution. Cooper envisions school classes printing books of essays, people compiling family recipe books, or just aspiring authors yearning to see themselves in print…

The Digital Commons' other major component is what DCPL calls the "Dream Lab." About one-third of the space is carved up into meeting spaces and cubicles outfitted with various devices for collaborative work. Cooper is expecting to attract a long list of startup companies and community organizations that might not have permanent offices of their own, but still need resources like wireless Internet access, DVD players, visual projectors, and Smart Boards, interactive whiteboards that feature speakers, projectors, and, niftiest of all, styluses that leave trails of digital ink the way one would use a dry-erase marker on an analog board.

It's this kind of service that will help libraries continue to fulfill their vital role in the community. We may not see this level of service in our smaller branches any time soon, but I could definitely see something like this at the central libraries of Winston-Salem, Greensboro and High Point.

 

The Rise of 14th Street

Leave a reply

As a teen growing up in Northern Virginia in the early 80s I'd venture downtown with some of my buddies to witness firsthand the depravity that was on display on 14th Street. I really was too stupid to realize how dangerous it was to go down there to park and watch hookers pick up johns, dealers sell their weed/coke/whatever and pimps managing their "personnel." To me and my buddies it was like going to live theater, except that when we saw the inevitable beatings, assaults and brawls and realized that the blood that was spilled and the bullets that flew were very real, we retreated to our suburbs and ventured downtown only to visit the clubs in Georgetown or Foggy Bottom.

It's from that perspective that I read this article in the Washington Post about the gentrification of the 14th St. corridor.  Whether or not you're a fan of gentrification you have to be amazed at how a city can literally be transformed.

The formerly riot-scarred corridor has gone into gentrification overdrive, a boom fueled by investors looking for a safe place to park hundreds of millions of dollars, the relative ease of obtaining a liquor license, and the arrival of thousands of new residents longing to live downtown.

The result: more than 1,200 condos and apartments and 100,000 square feet of retail are being built or have hit the market in just the past nine months. At the same time, at least 25 bars and restaurants have opened or are under construction along 14th Street, adding more than 2,000 seats to the city’s dining scene at warp speed…

The street’s renaissance began decades ago, with the establishment of Studio Theatre (founded in 1978 and expanded in 1987) and other performing arts venues. But the pace of change accelerated after a successful community lobbying effort to lure Whole Foods Market to P Street, between 14th and 15th streets. A steady progression of improvements followed, with carryouts, auto repair garages and pawnshops giving way to sit-down Thai restaurants, fitness studios and window displays of $5,000 sectional sofas.

This next part interested me from a professional standpoint since I work for an apartment trade association:

Veteran commercial real estate broker Andrew McAllister, who has done $1 billion worth of business along 14th, likened the District’s post-recession situation to last call on a Friday night.

Were we the “best-looking chick? We were the only chick at the bar,” he said.

Washington quickly found itself at the center of a national apartment building boom, spurred by the transformation of millions of former homeowners and would-be home buyers into renters. Many of them experienced unemployment or had their credit ratings decimated by foreclosure. Others couldn’t muster the bigger down payments required to obtain mortgage loans.

Washington’s status as an oasis of job security, in particular, made it one of the nation’s top destinations for the young, highly educated and affluent, putting the city on track to drawmore newcomers between 2009 and 2011 than it had during the previous decade.

A note for our folks here in the Triad: notice how important jobs were to the revitalization of downtown Washington? Our small cities are doing a great job focusing on the redevelopment of their downtowns, but until we get significant job growth it will be hard for our cities to really take off.

Lewisville 2013 Candidates Update

Leave a reply

With four days left to register we have the following candidates registered to run for seats on Lewisville's Town Council:

Mayor
Dan Pugh (Incumbent)

Council
Jeff Zenger (Incumbent)
Robert Greene (Incumbent)
Mike Horn (past council member)
Fred Franklin (Incumbent)
Ed Smith (Incumbent)
Ken Sadler (past council member) 

The only current members of the council who haven't filed are Sandra Mock and Tom Lawson, and since Mr. Lawson has reached his term limit he can't file.

If no one else files then this election will be dull as dirt since there are only six seats on the council, plus the mayor, so everyone will be running unopposed if things stand as they are. On the positive side we could save a lot of trees since our candidates won't have to print any signs.