Dr. Kipp
An interventional radiologist and former family practitioner, Dr. Van Camp is triple board certified. His extensive formal education includes medical training with two residencies and a fellowship covering a span of nine years of post-graduate education. Dr. Van Camp began his medical career practicing family medicine in Weston, Missouri, doing everything that family practitioners do, from delivering babies to pediatrics to elder care.Soon after, he completed a residency in diagnostic radiology at...Read More»
Medicare As a Business Partner
Posted May 16th, 2012 at 8:00 pm
If you were in business, and you had a contract with a major company that was responsible for 9-12% of your business, and that business sent you a letter saying they would be decreasing the amount of money they currently paid to you by about 30%, what would you say to this company? Imagine for a moment that you and this company had been in business together since 1965. Imagine, also, that over the years, the company had slowly and methodically begun decreasing their payment for your goods and services over the last decade; 2-3% one year, 5% another. Throughout the past generation you had already absorbed a 10% decrease in how much this company would pay for your services. At first, you were hesitant to let the company go, as they accounted for about one third of your business. You pondered the past, recalling the years of doing business together. Yet, you were quickly reminded how this company had changed drastically since its doors opened in 1965. You remembered the ease with which you initially had conducted business with this company, but how this had become more and more difficult with each passing year. The company’s level of bureaucracy had grown exponentially. The mounds of paperwork they now required just to submit your bill for fair and reasonable payment for your services had grown tiresome. Over the past ten years you found more and more of you and your staffs time wasted contacting the company and explaining and re-explaining what services you had just performed. You found the tenor of the companies employees had shifted from that of cordial customer service to a more confrontational and accusatory method. You realized you had shifted your own processes from cooperative to defensive, as a means of survival. You found the only way to deal with this company was to defend; your services, your documentation, your bill.
After much deliberation and thought, you finally came to the only reasonable conclusion; it was now time to sever your business relationship with this company. Even though you had a forty-seven year history with doing business with this company, and it bothered you greatly to remove them from your ledger, you realized that it was no longer cost effective, prudent or even feasible to continue this professional relationship. However, attempting to remain as objective as possible, you contacted one of your respected competitors who had also provided this company with goods and services, to see if they had experienced any of these same problems, and what you discovered shocked you.
You contacted the administrator at the Famous Clinic and asked them if they were still providing goods and services for this company, and the Chief Executive Officer laughed and said, we quit working with them almost two years ago. After you regained your composure, you asked a couple follow-up questions. Has it hurt your bottom line? No, it’s actually helped us, as we’re not wasting staff hours filling out all their forms and jumping through all of their hoops and still never getting paid. Have you ever regretted your decision? Not for a second; in fact, we have found that other businesses like you have contacted us weekly to see how we are doing after our decision to sever our ties with them. What we have learned since our decision two years ago, is that we all should have done this years ago. But, we were afraid to, because they had always been so big and powerful. One more question, would you ever go back? Not unless the entire companies methods of doing business are scrapped and a whole new way of functioning is implemented. Why should any business have to put up with the unbelievable inefficiencies and ineptitude that we have experienced with the company? And, they aren’t even nice or fair about it. In fact, they had become accusatory and hateful even in our daily business interactions. No, I would never allow Famous Clinic to return to working with this company.
Alright, I’m sure by now you have figured out what company or entity I’m referring, CMS, Medicare. In my hypothetical example, you may have even deduced that the Famous Clinic is synonymous with the Mayo Clinic. Doctors are facing this difficult decision daily. Many of us are even tortured at the thought of not participating in Medicare. We think about our geriatric patients who expect us to always be there for them. We remind ourselves we have always taken Medicare patients. To discontinue this relationship isn’t a decision made lightly.
As physicians, we realize better than most, that Medicare has been managed so poorly, and so ineffectively, that to continue to participate in Medicare would be professional suicide. With the focus now placed on a punitive model, in which the it’s assumed (wrongfully for the majority of physicians) that doctors willfully and egregiously engage in Medicare fraud, all for the almighty dollar, it is foolish to remain a provider in such a penalistic environment, professionally speaking. No other profession would accept or even consider remaining a participant in any like program. They would never allow their professionalism to be excoriated, as has been done to doctors. Nor would they accept the repeated unilateral pay cuts forced upon all Medicare providers over the last ten years. Diagnostic radiology has seen a decrease in their Medicare fees by over 35%. What profession would continue to provide their services for less and less money every year. And Americans have been duped into thinking that doctor’s fees are responsible for the cost of Medicare, yet doctors fees only make up 9-12% of total Medicare expenditures. Where’s the other 88-91% going? If the bureaucracy wasn’t so bloated with high paid employees and administrators, the doctors could be getting standard cost of living allowance increases each year, instead of having pay cuts forced down their throats.
Yet, the doctors are the ones who have to look their 65 year old and above patients in the eyes and say, I can no longer see you as a patient as I do not participate in Medicare. And, to have this discussion often times leads to hurt feelings and misunderstanding, as the patient has always trusted that the hared earned money they contributed to the Medicare system would insure them of accessible, affordable, high level medical care. And now, they are quickly realizing that the entire Medicare program has been mismanaged and in essence, bankrupted. Imagine, working your entire life, placing a portion of every dollar you earned into a health insurance fund, and another portion of every dollar earned into a pension plan, and then to turn sixty-five, and proceed to drawing upon your health benefits and your retirement pension, only to find out that the coffers of both programs are empty. Imagine the shear panic, and anger you would feel. Well, that’s nearly where we are with both Medicare and with Social Security.
So, when a doctor electively chooses to opt out of being a Medicare provider, instead of scrutinizing or criticizing him or her, let me inform you that these doctors are not alone, the respected and revered Mayo Clinic quit taking Medicare almost two years ago. And, if it’s good enough for Mayo, then it’s good enough for the rest of us…at least that’s my opinion.
Dr. Kipp Van Camp | Doctor’s Orders Radio Show | Misdiagnosed | An interventional radiologist and former family practitioner, Dr. Van Camp is triple board certified.
Dr. Hughes on Fox Business
Posted May 4th, 2012 at 3:33 pm
Dr. Kipp Van Camp | Doctor’s Orders Radio Show | Misdiagnosed | An interventional radiologist and former family practitioner, Dr. Van Camp is triple board certified.
The Future of Obamacare after Oral Arguments
Posted April 30th, 2012 at 9:08 pm
When it comes to the future of Obamacare, now that a month has passed since the oral arguments were presented to the Supreme Court, we wait passively, lulled to sleep by the slow process of our judicial system (and this case is being pushed through quickly!) There’s a false sense of security when it comes to Obamacare that this is an all or none proposition. Somehow, we have come to think if the SCOTUS decision is unconstitutionality on the individual mandate that the legislation just magically disappears. We tend to forget if the Supremes say “Not Constitutional” there’s still the matter of severability, the idea that a portion of the bill can be struck down, while the remainder remains intact. Apparently, reporters at the hearing tweeted that “Kagan indicated if a choice between leaving half-a-loaf and no loaf, half-a-loaf wins.” And the Wall Street Journal’s Janet Adamy tweeted, “ Ginsberg: If they must choose between wrecking operation and salvage job, salvage job is more conservative.” The Associated Press reported that “Sonia Sotomayor, Elena Kagan, Ruth Bader Ginsburg, Chief Justice John Roberts, and Antonin Scalia were open to the idea that the wide-ranging law contains provisions that can be saved,” even if the individual mandate requiring Americans purchase health insurance is struck down.
And then there’s the small problem that every day that passes, there’s more and more of the Patient Protection and Affordable Care Act being implemented, slowly and methodically, piece by piece. To simply expect each and every one of those changes to simply be reversed, or done away with, even if the Court said the entire bill is unconstitutional and must go. And, of course, there’s the little matter of Congressional repeal required to actually strike down the current legislation, not a “gimmee” by any means.
Within the PPACA there are requirements for health insurance companies to cover everyone at reasonable costs, regardless of any pre-existing or debilitating medical conditions. This falls under the “guaranteed issue and community rating provisions” within the bill. In fact, only Sotomayor questioned the need to keep this provision, and so it’s assumed that the Court has already decided if they strike down the individual mandate, they should also do away with the guaranteed issue and community rating provision, as they recognize that this provision is unsustainable, impractical, and will ultimately result in private insurance companies ultimately failing and declaring chapter eleven.
Can we accurately read between the lines? Has the High Court tipped their hand? Do we now get a sense of their voting conscience? Using plain old deductive reasoning, it does appear that the Justices are hinting to us that they may indeed declare the individual mandate unconstitutional. Certainly, if they don’t it presents a whole host of new problems for them. What requirement will the government place upon the American people next? But, a vote against the constitutionality of the mandate is now beginning to suggest that the absence of the severability clause is likely going to be overlooked. From the justices initial reactions, it seems they have decided that they can strike down certain portions of the legislation, while leaving the bulk of the law intact.
Of course, if they go about exercising their apparent right to “line-item veto” individual parts of the law, they may end up backing the American people into a corner they aren’t anxious to reside. If the individual mandate is struck down, and I do believe the Congress has overstepped its boundaries with this requirement, then how can the law effectively improve the issues we currently have with our health insurance system. If the “45 million” Americans who are uninsured simply choose not to purchase health insurance, as the individual mandate had been removed from the PPACA, then what good is anything else in the bill? And, didn’t we initially begin this discussion of health reform back in the 1990’s under the Clinton administration. If the main reason to even consider health reform for America in the first place was to assure that all Americans had insurance, and if the requirement to purchase or acquire health insurance is removed, what prevents those citizens within the uninsured pool who have made the conscious decision to not carry health insurance for whatever the reason from now sticking to their previous stance of not having any health insurance. And certainly, the remainder of the PPACA is not so overwhelmingly attractive that this subgroup of the uninsured will now suddenly be unable to live without the government’s health plan.
And, basically, I’m only looking at one of the many tenets of Obamacare, and one can see how the “line-item veto” approach to judicial matters, is fraught with its own set of problems. Even though I am completely opposed to the PPACA, for it to have any chance of accomplishing anything positive at all, it must be passed in its entirety, or removed in its entirety. A cafeteria approach to “fixing” this legislation only causes even more chaos and complication. If you asked me, I’d suggest the only real solution is for Congress to repeal the entire PPACA, in spite of any oral arguments taken before the Supreme Court, and then we start over with a reasonable and realistic health reform plan, that maintains its roots in the private sector, as does the Ryan plan. But, I doubt that this is the course of action we’ll take, as its way too logical and practical.
Dr. Kipp Van Camp | Doctor’s Orders Radio Show | Misdiagnosed | An interventional radiologist and former family practitioner, Dr. Van Camp is triple board certified.
Dr. Kipp talking about Obamacare on CHW Radio
Posted April 18th, 2012 at 8:50 pm
Click on the Book above to listen to the show!!
Dr. Kipp Van Camp | Doctor’s Orders Radio Show | Misdiagnosed | An interventional radiologist and former family practitioner, Dr. Van Camp is triple board certified.
PPACA HHS Slush Fund
Posted April 12th, 2012 at 3:01 pm
As you know, the Supreme Court heard oral arguments regarding the landmark Affordable Care Act (ACA) almost two weeks ago. Logic would tell each one of us who strive to be informed and who attempt to remain up-to-date with important current events, like a nationalized health plan, that nothing should be done regarding the health reform law, until after the Supreme Court issues their ruling, in mid to late June. Logic suggests that Congress, the current administration, and the federal governmental agencies would focus their attention on other matters, until after the ruling is made. And logic reminds us that the current health system, with its flaws and shortcomings (including the rising costs and the many problems of our health system) that people still need medical care, even during the months spent waiting for the SCOTUS ruling, and so medical care should continue as needed. Or, in other words, wouldn’t we apply a moratorium on the Patient Protection and Affordable Care Act (PPACA), no longer implementing any of the policy, until after we know the Justices opinions on constitutionality of the PPACA, and that the current medical system would continue to function as it has for years.
Well, unfortunately, we are dealing with a body of powerful individuals, who either fail to think logically, or we are watching a group of people who ignore the obvious, as they have an overconfidence that they know what is best for us, regardless of what we, the American people, think. On April 9th, 2012, the current administration diverted $500 million to the Internal Revenue Service (IRS), earmarked to help implement the PPACA. This money falls outside of the standard appropriations process. This money comes from a $1 billion implementation fund, which many have referred to as a “slush fund.” The $500 million transfer isn’t new for the Human Health and Services (HHS) department, as HHS transferred $200 million to the IRS over the last two years, and plans to transfer more than $300 million the rest of this year, according to a congressional aide. The $1 billion fund was set aside for “federal” implementation activities and is available for any governmental agency. However, the HHS has exercised its privilege of tapping into this fund more frequently than any other agency. The HHS reportedly plans to drain the entire fund by September, before the presidential election.
Another example of how the government has continued to move forward with implementing the PPACA is the request for $8 million for 2013, to assist with implementation of the individual mandate. The IRS has stated that they want to hire another 300 new employees next year to police the individual mandate and to collect the numerous new taxes laid out in the PPACA, such as new fees on drug companies and insurance policies, to name a few. When asked, an IRS spokeswoman would not release just how much money has already been spent thus far in their implementation of the individual mandate.
What makes this so frustrating to those of us who go to work every day for a fixed salary, and then pay our fair share (and in most cases more than our fair share) of the overall cost to run the US government is that it’s our tax dollars that continue to foot the bills for these types of “slush funds.” And then, the disingenuousness of the process is egregious. The HHS apparently plans to use every penny of this $1 billion fund. And the IRS plans to become a police state to make sure that each and every one of us participates in the required purchase of health insurance, as well as, the police state for collecting the penalties, fines and fees now placed on drug companies and insurance companies, in order to help pay for the PPACA. This foundation is being laid before our very eyes, in preparation of full implementation of the PPACA, regardless of what the Supreme Court decides.
Whether or not one even agrees or disagrees with a socialized health care system, or health reform, wouldn’t it seem logical and reasonable to halt all activity (like the HHS tapping into the $1 billion “slush fund”, or the IRS hiring 300 more employees to collect the fees, fines, and penalties), at least until after the SCOTUS decision has been made. Shouldn’t all health reform activity cease, until the US Supreme Court decision is finalized? I suppose that seems too fair and too logical. As is evident from the last forty years of Congressional or Governmental decisions and actions, we are not dealing with fair-minded or logical individuals.
So, what is the real motivation for ramming this plan down the American people’s throats? It appears to me that the driving force behind the PPACA isn’t to assure that all Americans have health care, even though that’s what we are being told daily; I believe this is more about control, power, and money. Of course, don’t think I’m so intelligent or logical. Anyone who is thoughtful and analytical would draw the same conclusions, as no other profession would be allowed to proceed, if a landmark decision that would shape their profession for years to come lay at the feet of the Supreme Court. Under any other circumstances, all activity would be frozen until after the Justices had made their ruling. There would be a moratorium placed on any other professional activity, in any other similar type of situation in which the Supreme Court had been asked to render an opinion about the legality or constitutionality of any other policy. That would be the only logical and prudent course of action. However, since that is not what is being done, then I believe that alerts us that something else, besides providing health care for all Americans, is the motivational and driving force behind this law. And when I attempt to read the health reform tea leaves, the conclusion I draw from the current activities, is that this case is about money, power, and control. At least, that’s my opinion! What do you think?
Dr. Kipp Van Camp | Doctor’s Orders Radio Show | Misdiagnosed | An interventional radiologist and former family practitioner, Dr. Van Camp is triple board certified.
PPACA and Tort Reform
Posted April 4th, 2012 at 5:24 pm
On April 4th, 2012, the Associated Press reported that doctors need to quit ordering additional medical tests for each of their patients. The overall point of the brief sound byte was that physicians order extra diagnostic studies, to protect themselves from being sued. Surveys and polls of health care workers for the past two decades in America have concluded that doctors overwhelmingly admit to practicing “defensive medicine.” A study conducted by the American Medical Association, in 2010, revealed of the 1231 physicians surveyed, 91% responded that they order more tests and procedures than needed in order to protect themselves from malpractice suits.
Many members of Congress have strongly claimed that they will never consider medico-legal tort reform and have encouraged their colleagues to follow suit, because it is their responsibility to protect the patients and the American citizens from medical negligence. They say that doctors want tort reform so that they can practice cavalier, careless medicine, and not be held accountable. They lead their constituents to believe that they are champions of compassion and compunction, but that doctors collectively are irresponsible and perfunctory. They deny the medical providers claim that they believe they must practice defensive medicine, as the statement to physicians just out of training today is: “it isn’t if you get sued any more, it’s when and how many times.”
The politician’s ignore the facts, or misrepresent the truth whenever it is expedient to their cause. The facts show consistently that doctors practice defensive medicine, and the reason for this practice pattern is the fear of liability. The media is willing to suggest that doctors must curtail their excessive ordering habits to control costs. Health care costs are growing at exponential rates, and all doctors are certainly cognizant of this problem. Congress and the media accusingly reprimand doctors that we must quit ordering all of these diagnostic tests, reminding us that American medicine is too costly. Yet, when the medical providers push back with a plausible explanation, like, we would happily trust our clinical skills, and decrease the number of studies and procedures that we require of our patients, if Congress would simply enact some reasonable reform of our medical legal system, they refuse to listen.
As long as tort reform remains a sacred cow with our Congress, we will never see legitimate control of our health care expenditures, nor will we truly reform our health system. On the American Association of Justice, AAJ, (formerly known as the Association of Trial Lawyers of America-ATLA) website, under the newsroom section, they have an article titled “The Truth about ‘Defensive Medicine’, Debunking the Myths.” The AAJ, in spite of the overwhelming proof that doctors practice defensive medicine, spend their time, effort, and resources trying to persuade anyone willing to listen that doctors don’t actually practice defensive medicine. And they’re the some of the same people claiming that doctors need to quit ordering all of the extra, expensive, diagnostic studies. Let me ask the AAJ, why do doctors order these additional studies and procedures?
The 112th Congress (435 US House, and 100 US Senate, total of 535) has 202 attorneys (down from 203 attorneys in the 111th Congress). 37% of our Congress are attorneys. Any decision about medico-legal tort reform will never be legitimately discussed and considered, as long as two-fifths of Congress are lawyers. This group will never seriously consider honestly examining the current medical liability system in our country. Yet, when they are up for re-election, they’ll tell you vehemently that they’re simply spokes persons for their constituents. If this were really true, then why wouldn’t they live by the same standards they require of the American citizens; their constituents? Instead, they exempt themselves from the Patient Protection and Affordable Care Act (PPACA), they designed automatic cost of living adjustment (COLA) salary increases applied to their salaries every year, and their retirement and pension plans are superior than most.
Will we really see legitimate health care reform anytime soon? As long as 37% of Congress are attorneys, and as long as this powerful body of politicians refuse to honestly discuss tort reform, we will never see real and lasting health care reform. But one thing is certain, we’ll continue to chastise and reprimand the doctors for liberally ordering expensive and unnecessary studies, until doctors are finally fed up to the point of standing together, or until they simply throw their hands in the air, and find a new way to make a living.
Dr. Kipp Van Camp | Doctor’s Orders Radio Show | Misdiagnosed | An interventional radiologist and former family practitioner, Dr. Van Camp is triple board certified.
A Great Video on Obamacare from docs4patientcare
Posted March 30th, 2012 at 7:46 pm
Dr. Kipp Van Camp | Doctor’s Orders Radio Show | Misdiagnosed | An interventional radiologist and former family practitioner, Dr. Van Camp is triple board certified.
PPACA Spin
Posted March 29th, 2012 at 1:46 pm
Let the SPIN begin. The word doctors are busy weaving the happenings of the last forty-eight hours, into their own palatable ball of wool. Let’s be fair to the journalists of today, aren’t they at their best when they’re taking the facts, twisting and turning them into the expected and desirous case. No longer is being a “reporter” about collecting and disseminated the truthful and accurate happenings of the event, instead being a journalistic writer is about molding and shaping the “facts” into a “sound byte sculpture” that meets the expected terms of the establishment’s agenda. Using vernacular of the twenty-first century, this is what’s known as the main stream press.
I fully expect the news reporters, broadcasters, pundits, and professional bloggers to come out in droves with their own explanation of what has happened on the floor of the US Supreme Court during the last three days. And if you are well informed and have a modicum of common sense, what you hear will be something significantly different than what you thought you observed. A coach will often say that it’s the talent of the athletes that makes coaches appear smart. I suspect throughout the AP cubicles across America, the writers are bemoaning how the governments “athletes” performed less than adequate, or that their level of talent failed to meet their expectations. Never fear, that just means in order to make the “journalistic coach” look smart will take a bit more imagination and a greater challenge. From what I’ve seen and heard over the last decade, I am confident, the AP establishment is up to the challenge.
I predict, before the sun sets, the Spin will sound something like: even though the government attorneys that presented their oral argument to the US Supreme Court Justices appeared timid and unprepared, this was actually their intent. They hoped to establish themselves as “the underdog”. And anyone who enjoys competition of any sort, appreciates the courage of the “underdog”, and generally finds themselves sympathetic to the overwhelming challenges they face. By appearing meek and unpolished, they actually found favor with the Court and with America. Their tactics, though unconventional, were genius. Doesn’t an opportunity to take your case before the highest and most intellectual body in the land mandate unconventional and unique? When one ponders all of the thousands of cases that have been argued before the Supreme Court, how many of these followed the conventional and predictable course. Not these courageous litigators, they developed a new, and refreshing tactic, to come across as humble, even self-deprecating, which in turn displayed their brilliance. I fully expect to hear some of these statements before the day is over.
It will not surprise me in the least if the pundits claim that the public appreciates how the political establishment, generally reserved for the elite of our society, actually went into battle representing the everyday Joes who are unable to defend themselves? Isn’t that what the entire Patient Protection and Affordable Care Act (PPACA) is all about, a willing and helpful government, whose benevolent purpose is to provide health care for all of those uninsured Americans who simply cannot help themselves? Aren’t the attorneys who are arguing this landmark case before the highest court in the land, no different than David slinging a few health care stones at the mighty Conservative and uncaring Goliath who doesn’t understand or care about those poor Americans who, at no fault of their own, are uninsured? Isn’t that what this is all about, these uninsured underdogs of our society being shut out of hospitals, and being denied medical care because of their pre-existing conditions? Isn’t this about all of the less fortunate citizens throughout America, who have been overlooked and ignored, until now? Thanks to a compassionate group of attorneys, who grasp the plight of the poor, the tired, and the forgotten forty million uninsured Americans, their one small voice will be heard loudly before the US Supreme Court. And that’s why their methods, though unorthodox, are genius, because they show us all that they truly get it. This is what I fully expect to hear before this day ends.
Yes, I fully expect the Spin doctors to begin explaining to the well-informed silent majority that the appearance of timidity and the lack of preparation was actually the intent, and that we will be surprised at just how effective this technique was. And, if we let our guard down for even a second, we may realize, whether intentional or by accident, that the overall effect of the past three days did serve a valuable purpose for the current administration, it managed to lower the bar, even if only a bit. And it gave the supporters of the PPACA a huge gift; it took the entire onus for providing health insurance directly off of their own shoulders and shifted the onus directly upon the shoulders of the other team.
And, if the Court unexpectedly declares that the health insurance mandate is indeed unconstitutional, then the supporters will immediately claim that the uncompassionate conservatives don’t care about the uninsured and less fortunate of our society. And unfortunately, this argument will likely stand, as long as we continue to ignore and deliberately refuse to engage in the discussion about the actual issue facing America, and it isn’t whether our underdogs should be required to purchase health insurance. The discussion we’ve failed to have, the question we’ve refused to answer as a society, is whether or not health care is a right or a privilege. And since we have passed directly over this discussion, like spectators at a sporting event, we will continue to be entertained by the performers in the ring, both the favorites, and the underdogs.
Dr. Kipp Van Camp | Doctor’s Orders Radio Show | Misdiagnosed | An interventional radiologist and former family practitioner, Dr. Van Camp is triple board certified.
The Supreme Court and Oral Arguments
Posted March 27th, 2012 at 10:02 pm
There’s new found excitement from the conservative ranks today. As the Supreme Court hears oral arguments there’s close observation of each justices response We hang on their every word excruciatingly squinting to read between their descriptive lines. If we listen closely and if we analyze critically we believe we can accurately predict how each justice will vote.
We ask ourselves, do their responses give us legitimate insight into how they think? Absolutely! The words that spew from our mouths generally come from deep inside our heart. Generally, but not always! Can we assess their statements throughout the three or four days of oral arguments and then draw an accurate conclusion? By reading their actions and reactions can we accurately predict which side of the constitutional mandate they will fall?
I would state a resounding “no way!” Just because Justice Roberts chose to go toe to toe with government council does not enable us clear vision as to how he will vote. Just because Justice Kennedy has offered descriptive and compelling arguments explaining the unconstitutionality of the individual mandate is not truly indicative of his innermost thoughts regarding the Accountable Care Act (ACA) and certainly does not provide us high predictive value into how he will vote. Especially knowing that Justice Kennedy purportedly holds the decisive swing vote.
Even though the highest court in the land is responsible for legal interpretation rather than political legislation, the reality is at this time in American history, the court has positioned itself as a body of politicians or legislatures, rather than a group of jurists. Seemingly they would rather shape and influence politics.
And therefore, I believe that Justice Roberts and Kennedy’s statements are more similar to posturing or politicking, rather than a window into their intellectual soul.
I won’t be surprised in the least if after all arguments are made, and our initial excitement or sense of security in the initial reaction from our US Supreme Court Justices with regards to the lack of constitutional authority for an individual health insurance mandate and after the parliamentary dust settles, we hear a loud and clear, “however”!
I’m expecting a response something like this from The Court in the near future…”However, even though Congress cannot impose mandates on essentially all products and services, health care is unique and therefore not like any other American product or service. Therefore, the American people must not look at this as our US government telling each of us that we must purchase health insurance. Instead we must reshape our thinking from a required mandate to a desired participation. We should think of this as being prescribed that distasteful medicine that we need to cure whatever disease is ailing us. Like that bitter cough syrup our old General Practitioner (GP) prescribed 50 years ago. We should want to participate in this national health plan because it will be good for us.” this is the response I personally am expecting from The Court. And I think their explanation will go something like this…”And the most important thing to remember is that patients (American citizens) don’t always know or appreciate what is best for them. Like a parent nurtures their child, or like a doctor treats their patient, the government knows better than we do, and therefore, we should want to participate in, say healthy eating, whether we like, say broccoli, or not, because it is good for us.”
Thus, when one looks at how the Supreme Court is posturing regarding individual mandates, it’s imperative to remember things are not often as they appear. Or, what you see isn’t always what you get. Therefore, I for one, will not be surprised after all the Supreme Court dust settles, if there’s a big “but” standing in the doorway claiming the individual mandate in this particular situation is acceptable, constitutional, but most importantly what is best for each one of us.
Also, don’t forget, even though we are examining this issue critically this week, for the past two years the PPACA has been the law and much of it has already been implemented. If I’m wrong and the Supreme Court does decide this health insurance requirement is unconstitutional, the court can’t simply snap their fingers and have the PPACA magically go away. And if your waiting for their opinion to be given at the end of this week, don’t hold your breath, because they won’t officially make their ruling until mid summer, which gives the politicians plenty of time to persuade The Court to change their collective mind.
Dr. Kipp Van Camp | Doctor’s Orders Radio Show | Misdiagnosed | An interventional radiologist and former family practitioner, Dr. Van Camp is triple board certified.
The PPACA and ACO’s
Posted March 19th, 2012 at 8:31 pm
In order to address the rising costs of healthcare, several different health delivery models have been proposed. Lets’ take a close look at ACO’s, Accountable Care Organizations. The ACO is included in the PPACA, the Patient Protection and Affordable Care Act. ACO’s take up only 7 pages in the massive legislation, yet, this network of providers has received much attention in the news, in the past year. Let’s take a closer look at some of the specific language used to describe what an ACO is.
An ACO is a network of doctors and hospitals that share in the responsibility for providing medical care to patients. The details of the parameters for which ACO’s will function are still being determined, but some of the specifics have been revealed. For example, one of the provisions is that ACO’s would agree to manage all of the healthcare needs of a minimum of five thousand Medicare beneficiaries for at least three years duration.
Harold Miller, president and CEO of the Network for Regional Healthcare Improvement and executive director of the Center for Healthcare Quality and Payment Reform in Pittsburgh, Pennsylvania suggests we should think of ACO’s as buying a television. Take for instance Sony Corporation, which may contract with many suppliers to build individual television sets, ACO’s would bring together all of the various components needed to provide health care for these five thousand Medicare patients, like: the physicians, the hospital, and the ancillary services such as home health care and physical therapy, just to list a few. This would ensure that all parts are working together to provide the individualized health care services that each patient needs.
Currently, patients receive each of these components separately from multiple different sources. By contract with an ACO to provide the entire gamut of care, this will make the system more efficient and the odds of duplication significantly less likely. Instead of solving each patient’s medical needs with numerous unrelated services, the hope is to provide each patient their total medical care under “one roof”, so to speak.
In theory, some of this makes sense, as it is true that many services are repeated and duplicated, rather than only provided once. When a patient is seen by their PCP (Primary Care Provider) the doctor may order specific lab and x-ray studies. If the patient is referred to a specialist, this doctor will likely re-order some if not all of the studies that have already been performed. This duplication of services has proven inefficient, and highly expensive. So, in theory, ACO’s may just work to make the patient experience more cost effective and more efficient for each patient. However, these organizations remain in their infancy, and it’s uncertain whether their claim to keep costs and duplicated services down, are not yet proven.
Like any new potential solution to a multi-faceted problem, the proposed solution must be given ample time and resources to determine whether the claimed benefits actually come to fruition. Considering how inefficient our current state of medical affairs are, it seems reasonable to give ACO’s a chance to succeed. If they do everything that the proponents of these organizations claim, this may just be one of the answers to our health care delivery system problems. And if the ACO’s fail, like Thomas Edison and the electric light bulb, we will have found yet another example of how not to solve our nation’s health care problems. And this in and of itself, does provide some secondary benefit.
Dr. Kipp Van Camp | Doctor’s Orders Radio Show | Misdiagnosed | An interventional radiologist and former family practitioner, Dr. Van Camp is triple board certified.
